Increased erasure. Erased teeth, how to fight? Treatment Erasure of hard tissues of the tooth

Beautiful teeth- the best reward from nature. But what if the enamel starts to thin? Most likely, your dentist will laugh it off, saying that this happens to everyone. However, when the problem becomes noticeable not only for you, a real panic begins, because no one will put up with the fact that the teeth simply “melt” every day.

Erasing teeth is not always negative. For example, physiological abrasion is an adaptive process associated with changes in the periodontium. It is needed to improve chewing of food, to prevent overloading of the teeth. Pathological form differs in earlier and considerably expressed course.

A decrease in the volume of hard tissues of the teeth, as a rule, is observed in people over 40 years old, mainly in men. Less commonly, pathology is observed in children and adolescents.

Tooth abrasion: main symptoms

In addition to external signs, such as a violation of the anatomical shape of the crown, a decrease in the interalveolar height, aesthetic changes in the face, periodontal damage, the problem may be accompanied by physiological disorders. These include pain in the muscles of the face, in the temporomandibular joint, frequent headaches, discomfort in the neck. There may also be a deterioration in hearing or vision, a characteristic crunch in the jaw joint, and a violation of salivation.

Erasure of teeth: causes of pathology

Dentists distinguish 3 main groups of factors:

Insufficiency of hard tissues of teeth

• endogenous factors (congenital pathologies in the body, problems in the formation or mineralization of enamel associated with disorders endocrine system);
• exogenous factors ( unbalanced diet, which leads to a violation of mineral and protein metabolism, deficiency of vitamins D and E).

Strong abrasive effect on enamel

Increased acid exposure due to certain diseases of the gastrointestinal tract (for example, Achilles gastritis), enamel sensitivity, occupational harm to health (work in a chemical industry), frequent use very hard food, use of low-quality toothbrushes.

Excessive functional load of teeth

Not correct bite, partial adentia (absence of some teeth), features of chewing food, making poor-quality dentures, medical errors during prosthetics or fillings, bruxism (teeth grinding during sleep).

Types of pathological abrasion of enamel

By localization, erasure can be horizontal, vertical or mixed.

According to the course of the process, there are:

• generalized abrasion (spilled - extends to all teeth);
• localized (limited to a certain area, for example, on the front teeth);

Bracco's classification (degrees of pathology):

• І erasure of cutting edges;
• II erasing of tubercles to dentine;
• ІІІ reduction of the crown size by a third;
• IV abrasion at the level of the root neck.

Treatment and prevention of enamel abrasion

It is very important to stop the progression of the pathology, and for this the doctor must find out the individual causes of its occurrence. To restore the anatomical shape of already worn crowns, veneers, inlays, and crowns are used. To increase the height of the bite, filling is carried out with metal ceramics or photopolymers.

If one or more teeth are missing, it is advisable to carry out dental implantation or removable prosthetics.

In case of malocclusion, it is necessary to undergo full-fledged orthodontic treatment (as a rule, vestibular bracket systems are used for this). If you are worried about bruxism, then everything is much simpler here - the dentist will make a special mouthguard that will need to be worn at night.

With increased exposure to acid on the enamel, it is recommended to rinse the mouth with a solution of soda.

The best prevention of increased enamel abrasion is proper nutrition, giving up bad habits and, of course, regular check-ups at the dentist. You can choose a competent specialist on our website. We have collected a complete database of dentists.

Increased tooth wear is pathological process speed sewing upper layers hard tissue, i.e. enamel. It is worth noting that this process is normal and it begins immediately after teething, the degree of its severity consists of many factors: heredity, hardness of food, composition of the water that a person consumes. But the teeth should be erased, of course, within reasonable limits - this should not be noticeable. If there is increased abrasion, which, moreover, can be noticed, then this, of course, is a pathology. But let's look at the problem in more detail.

Physiological abrasion

Erasure of hard tissues of teeth is normal - natural process, which is designed to help adapt to the load. It is uniform, no local overload is observed when it comes to the normal structure of the dentition. The result of erasure is a gradual change in the contacts of the antagonist teeth, a change in the angle of inclination so that the occlusion is correct.

Important! Physiological abrasion is distinguished mainly by the fact that it affects only the enamel - normally, the dentin is not exposed, and the areas of enamel in the area of ​​the contact planes of the teeth are subject to abrasion.

Milk teeth are also subject to partial abrasion. So, by the age of 3-4, the teeth of the incisors and the tubercles of the canines and molars are erased, and by the age of 6, erasing to the dentin is allowed. Its erasure can be up to 13-14 years, that is, until a complete change. O increased abrasion they say when the cavity shines through or the crown is lost almost completely, that is, there are 4 and 5 degrees of erasure.

Causes of pathological abrasion

The causes of the disease often lie in the presence of bad habits - when a person gnaws objects (nails, pens, pencils) or holds them in his mouth, loves nuts and seeds, and also prefers foods with high acidity. In addition, the disease may be the result of bruxism and other violations of the tone of the masticatory muscles.

The disease can also be caused constant reception some medicines, diseases of the gastrointestinal tract, accompanied by reflux of gastric acid or frequent vomiting, diseases of the heart and blood vessels, nervous and endocrine systems.

And finally, inappropriate or poor-quality orthopedic constructions, crowding of teeth or other bite defects can lead to abrasion.

Symptoms of pathology

Symptoms of pathological abrasion include a number of disorders:

• change in the anatomy of the crown, i.e. decrease in height
• hyperesthesia - hypersensitivity under temperature, mechanical, chemical influences,
• damage, ulcers of the mucous membrane - this is due to the presence of sharp edges of the teeth,
• malocclusion, as a result - the loss of hard tissues due to improper distribution of chewing load,
• decrease in the height of the lower third of the face - omission of the corners of the mouth, clearly marked nasolabial, chin folds,
• pain different nature in the temporomandibular joint, facial muscles, neck muscles - if there is dysfunction of the temporomandibular joint.

Many of the signs can be attributed to the consequences and complications of the underlying disease - they form later, as the erasure progresses.

“Abrasion can affect one, several teeth or the entire dentition. It depends on the specific reason. So, if the problem is in the excessive height of the artificial crown, the loss of hard tissues will be observed on one antagonist tooth. If we are talking about crowding on the one hand, the remaining half of the dentition will “suffer”. If there is a malocclusion, all teeth can be subject to abrasion., - notes I. Volovonsky, a dental therapist with more than 17 years of experience.

Classification of increased abrasion, degree and form

The degree of tooth wear is determined by the most common classification by A.G. Moldovanova and L.M. Demner. The researchers took into account physiological abrasion and identified normal rate– up to 0.042 mm/year. According to the age norms, there are three degrees:

1. by the age of 25-30, bumps and cutting edges are smoothed out,
2. by the age of 45-50, the enamel is only partially erased,
3. by 50 or more, the abrasion reaches the border of enamel and dentin.

According to Bracco, the process is classified as follows:

1. smoothing edges and bumps,
2. erasing of tubercles completely (on 1/3 of the coronal part), exposure of dentin,
3. crown height reduction by 70%,
4. distribution of the process to the neck, i.e. almost to the gum.

According to Grozovsky, 3 forms of increased tooth wear are distinguished:

• horizontal,
• vertical,
• mixed.

According to Courland, it is customary to distinguish 2 more types: localized and generalized pathology. The degrees are presented as follows:

1. spread to enamel and a small part of dentin,
2. distribution at the border of the main dentin,
3. transillumination of the cavity, erasing to the replacement dentin,
4. erasure of the entire coronal part.

The Bushan classification implies not only the stages of development of the pathology and the depth of the lesion, but also the extent, changes in functions, and the plane of the tooth. The researcher also identified 4 degrees - the first is characterized by exposure of the dentin and a shortening of the crown height by 30%, this figure gradually increases and reaches 80% by the 4th.

Erasure Diagnostics

The defect is diagnosed using comprehensive examination. It includes a verbal survey, clarification of the etiology, a visual assessment of the state of the oral cavity, the shape of the face, the height of its lower third, and bite characteristics.

The doctor can study the state of the masticatory muscles and TMJ using electromyography, tomography of the joint, and an x-ray. In order to draw up a correct treatment plan, it may be necessary to conduct electroodontodiagnostics, panoramic X-ray or radiography of individual groups of teeth. Based on the results obtained, the specialist specifies the type, form, degree of the disease, determines the characteristics of the bite and offers a method of treatment.

Treatment of pathological abrasion

What to do if the diagnosis is confirmed? The doctor will offer treatment tactics based on the state of the dental system, the complexity of the case, the severity of the disease. There are two treatment options: therapeutic and orthopedic.

Therapeutic treatment of tooth abrasion consists in the application of drugs to strengthen tissues, reduce hyperesthesia (high sensitivity). Such drugs are available in the form of solutions and gels, as well as pastes for application. Auxiliary way is physiotherapy. Widely used pastes and materials that seal the dentinal tubules. The mechanism of action depends on the specific composition: some of them act mechanically, the drug itself seals the tubules and reduces sensitivity. As a rule, we are talking about products in the form of varnish. Others act differently: they block the transmission of a nerve impulse. Therapeutic methods also include restoration - restoration of the surface with the help of composite materials.

Orthopedic treatment consists in the selection and installation of prostheses. However, it is worth considering that in some cases, prosthetics are preceded by other measures to eliminate the cause of abrasion or stop the pathological process. So, with a significant progression of the disease, it is important to restore the bite height with the help of special dental and periodontal trays. Mouthguards will also be required for bruxism, which will slow down the destruction.

Installation of crowns

Metal-ceramic crowns are one of the the best options prosthetics with increased abrasion. They can significantly reduce the load and completely restore the shape and function of the tooth. In this disease, all-ceramic crowns or based on zirconium dioxide are most often used, since they are distinguished by high strength characteristics. Metal ceramics will cost from 7.5 thousand rubles, but constructions based on zirconium dioxide and ceramic crowns will cost about 20-30 thousand.

Stump tabs

Severe tooth decay may require the installation of stump inlays that exactly follow the shape of the dental canals. This is a long-term solution that requires a healthy, preserved root. With healthy peridental tissues, it will last a long time - the strength indicators of such a solution are also very high. The cost of such a solution is from 4500 rubles.

Microprosthetics - veneers, lumineers

Artificial structures - ceramic inlays, veneers - are created in dental laboratories. An inlay is the optimal solution when there is significant loss of dentin. Veneers and lumineers will serve optimal way restore both aesthetics and protect teeth from abrasion.

“For a long time I struggled with crowding of teeth on one side with the help of braces. The dentition was aligned, but on the one hand, the upper incisors were heavily worn out during the time when the crowding was. I decided to install lumineers - and I didn’t have to whiten my teeth, and I solved the problem with different sizes of teeth. ”

Irina M., fragment of a message from the woman.ru forum

The cost of a veneer with installation on one tooth is an average of 20 thousand rubles, lumineers - about 40 thousand.

You can prevent increased abrasion by ensuring the correct bite. It is important to timely pay attention to diseases of the tone of the masticatory muscles, take measures in the presence of crowding of teeth, adentia, and also deal with bad habits. Nutrition also plays important role– it is necessary to ensure a normal balance of vitamins and minerals.

Related videos

1 Mandra Yu.V., Ron G.I. Ways to improve the effectiveness of treatment of the early stage of increased tooth wear, 2011.

Pathological tooth wear- polyetiological origin pathological condition dental system. It is characterized by excessive loss of enamel or enamel and dentin of all or only individual teeth.

Pathological abrasion of teeth occurs in middle-aged people, reaching the highest frequency (35%) in 40-50-year-olds, and in men it is more common than in women. Against the background of congenital pathology of development, pathological abrasion of teeth is observed in people and adolescents.

Etiology and pathogenesis

The occurrence of pathological abrasion of teeth is associated with the action of various etiological factors, as well as their various combinations.

It is conditionally possible to distinguish 3 groups of causes of pathological abrasion of teeth:

1) functional insufficiency of hard tissues of teeth;
2) excessive abrasive effect on hard tissues teeth;
3) functional overload of teeth.

Functional insufficiency of hard tissues of teeth. This deficiency may be due to endogenous and exogenous factors. Endogenous factors include congenital or acquired pathological processes in the human body that disrupt the process of formation, mineralization and vital activity of dental tissues.

Congenital functional insufficiency of hard dental tissues may be the result of pathological changes in ectodermal cellular formations (enamel inferiority) or pathological changes in mesodermal cellular formations (dentin inferiority) or a combination of both. At the same time, such a developmental disorder can be observed in some general somatic hereditary diseases: marble disease (congenital diffuse osteosclerosis or osteoporosis of almost the entire skeleton); Porak-Durant, Frolik syndromes (congenital osteogenesis imperfecta) and Lobstein's syndrome (late osteogenesis imperfecta). This group of hereditary lesions should include Capdepon's dysplasia.

With marble disease, delayed development of teeth, their late eruption and changes in the structure with a pronounced functional insufficiency of hard tissues are noted. The roots of the teeth are underdeveloped, root canals are usually obliterated. Odontogenic inflammatory processes differ in the severity of the course and often turn into osteomyelitis.

In Frolik and Lobshtein syndromes, the teeth are of normal size and regular shape. The color of the crowns of the teeth is characteristic - from gray to brown with a high degree of transparency. Degree of staining different teeth different in the same patient. Erasure is more pronounced in the incisors and first molars. The dentin of the teeth in this pathology is not sufficiently mineralized, the enamel-dentin junction looks like a straight line, which indicates its insufficient strength.

The same picture can be observed in Capdepon's syndrome. Teeth of normal size and shape, but with a changed color, different in different teeth of one patient. Most often, the color is watery gray, sometimes with a pearly sheen. Soon after teething, the enamel is chipped, and the exposed dentin is quickly worn away due to low hardness. Disturbed mineralization of dentin leads to a decrease in its microhardness by almost 1.5 times compared to the norm. The tooth cavity and root canals are obliterated. The electrical excitability of the pulp of worn teeth is sharply reduced. The affected teeth react weakly to chemical, mechanical and temperature stimuli.

Obliteration of the tooth cavity and root canals with this dysplasia begins even in the process of tooth formation, and is not a compensatory response to pathological abrasion. In the area of ​​the tops of the roots, rarefaction of the bone tissue is often noted.

Unlike functional insufficiency of teeth in Frolik and Lobshtein syndromes, Capdepon's dysplasia is inherited as a permanent dominant trait.

Acquired etiological endogenous factors of pathological tooth wear include large group endocrinopathies, in which mineral, mainly phosphorus-calcium, and protein metabolism is disturbed.

Hypofunction of the pituitary gland of the anterior lobe, accompanied by a deficiency of somatotropic hormone, inhibits the formation of a protein matrix in the elements of the mesenchyme (dentin, pulp). The same effect has a deficiency of gonadotropic hormone of the pituitary gland.

Violation of the secretion of adrenocorticotropic hormone of the pituitary gland leads to the activation of protein catabolism and demineralization.

Pathological changes in the hard tissues of the teeth in case of dysfunction thyroid gland associated mainly with hyposecretion of thyrocalcitonin. In this case, the transition of calcium from the blood into the tissues of the tooth is disturbed, i.e., the plastic mineralizing function of the tooth pulp changes.

The most pronounced disorders in the hard tissues of the teeth are observed when the function changes. parathyroid glands. Parathyroid hormone stimulates osteoclasts, which contain proteolytic enzymes (acid phosphatase) that contribute to the destruction of the protein matrix of hard tooth tissues. In this case, calcium and phosphorus are excreted in the form of soluble salts - citrate and lactic acid calcium. Due to the lack of activity in osteoblasts of the enzymes lactate dehydrogenase and isocitrate dehydrogenase, carbohydrate metabolism is delayed at the stage of formation of lactic and citric acid. As a result, highly soluble calcium salts are formed, the leaching of which leads to a significant decrease in the functional value of hard dental tissues.

Another mechanism of demineralization of hard tissues of teeth in the pathology of the parathyroid glands is hormonal inhibition of phosphorus reabsorption in the tubules of the kidneys.

Disorders in the function of the adrenal cortex and gonads also lead to demineralization of hard dental tissues, increased protein catabolism.

Of particular importance in the occurrence of functional insufficiency of hard tissues of the teeth, leading to their pathological abrasion, are neurodystrophic disorders. Irritation various departments central nervous system(CNS) in the experiment led to increased abrasion of enamel and dentin of the teeth in experimental animals.

To exogenous factors of functional insufficiency of hard tissues of teeth, nutritional insufficiency should be attributed primarily. Malnutrition (lack of minerals, protein deficiency of products, unbalanced diet) violate metabolic processes in the human body and, in particular, the mineralization of hard dental tissues.

Functional insufficiency of hard dental tissues due to insufficient mineralization can be caused by a delay in calcium absorption in the intestine with vitamin D deficiency, deficiency or excess of fat in food, colitis, profuse diarrhea. Highest value these factors acquire during the period of formation and eruption of teeth. The lack of vitamins D and E in the patient's body, as well as the hypersecretion of parathyroid hormone, inhibit the reabsorption of phosphorus in the renal tubules and contribute to its excessive excretion from the body, disruption of the process of mineralization of hard tissues. Such demineralization is also observed in kidney diseases.

Chemical damage to the hard tissues of the teeth occurs in chemical industries and is occupational disease. There is also acid necrosis of hard tissues of the teeth in patients with Achilles gastritis who take hydrochloric acid orally. It is necessary to emphasize the great sensitivity of tooth enamel to acid exposure.

Already in initial stages acid necrosis in patients there is a feeling of numbness and soreness in the teeth. There may be pain when exposed to temperature and chemical stimuli, as well as spontaneous pain. Sometimes patients complain of a feeling of sticking of the teeth when they are closed.

With the deposition of replacement dentin, dystrophic and necrotic changes in the pulp of the affected teeth, these sensations become dull or disappear. Acid necrosis usually affects the anterior teeth. The enamel in the area of ​​the cutting edges disappears, the underlying dentin is involved in the process of destruction. Gradually, the crowns of the affected teeth, being erased and destroyed, shorten and become wedge-shaped.

A significant violation of the functional state of hard tissues of teeth occurs in the conditions of phosphorus production. Necrotic changes in the structure of dentin were noted, in some cases - the absence of replacement dentin, an unusual structure of cement, similar to the structure of bone tissue.

Among the physical factors that reduce the functional value of hard tissues of teeth and lead to the development of pathological abrasion of teeth, special place occupies radiation necrosis. This is due to the increase in the number of patients undergoing radiotherapy in the complex treatment of oncological diseases of the head and neck region. In this case, radiation damage to the pulp is considered primary, which manifests itself in a violation of microcirculation with phenomena of pronounced plethora in precapillaries, capillaries and venules, perivascular hemorrhages in the subodontoblastic layer. In odontoblasts, vacuolar dystrophy, necrosis of individual odontoblasts are noted. In addition to diffuse sclerosis and petrification, there is the formation of denticles of different sizes and localizations, varying degrees organization. In all areas of dentin and cement, demineralization phenomena and destruction sites are found. These changes in hard tissues occur in various terms after irradiation and depend on the total dose. Biggest changes in the tissues of the teeth are observed in the period from the 12th to the 24th month after radiation therapy for neoplasms in the head and neck. As a result of significant destructive lesions of the pulp, changes in hard tissues are irreversible.

To prevent damage to the teeth during radiation therapy of diseases of the maxillofacial region, it is necessary to cover the teeth for the period of the irradiation session with a plastic mouthguard such as a boxing splint, conduct a thorough sanitation, and proper hygienic care.

The second group of etiological factors of pathological abrasion of teeth consists of factors of various nature, the common point of which is an excessively abrasive effect on the hard tissues of the teeth. Resident survey data Yamalo-Nenets District[Lyubomirova I. M., 1961] revealed big number severe cases pathological abrasion of teeth down to the level of the gums as a result of the consumption of very hard food by residents - frozen meat and fish.

S. M. Remizov’s long-term observations of the abrasive action of toothbrushes of various designs, tooth powder and toothpastes convincingly showed that improper, irrational use of hygiene and dental care products can turn from a therapeutic and prophylactic agent into a formidable destructive factor leading to pathological abrasion of teeth. Normally, there is a significant difference in the microhardness of enamel (390 kgf/mm2) and dentin (80 kgf/mm2). Therefore, the loss of the enamel layer leads to irreversible wear of the teeth due to the significantly lower hardness of the dentin.

A strong abrasive effect on the hard tissues of the teeth is also exerted by industrial dust at enterprises with high dust content (mining, foundry). Significant pathological abrasion of teeth occurs in coal mine workers.

Recently, due to the widespread introduction of porcelain and metal-ceramic prostheses into orthopedic dental practice, cases of pathological abrasion of teeth have become more frequent, the cause of which is excessive abrasive action of a poorly glazed surface of porcelain and ceramics.

The study of the surface of natural teeth and dentures made of various ceramic materials made it possible to establish that the surface of a natural tooth is smooth, without roughness, protrusions, and visible scratches are the result of mechanical wear. The state of the porcelain surface has a sharp difference, consisting in the presence of a significant number of irregularities of a pointed shape of a punctate nature or in the form of vitrified areas with the inclusion of sharp grains. Samples made from Sikor have a more uniform surface. Visible roughness of smaller dimensions with a large radius of curvature. However, breaking the glossy surface reveals the porous nature of the base material. A sample of cast glass-ceramic has a smooth surface, devoid of protrusions and roughness.

As a rule, the state of the surface is characterized by the number of irregularities per unit area, and the radius of curvature of the tops of these irregularities. In the interaction of antagonistic teeth, the actual contact area is of primary importance, which is directly proportional to the magnitude of the load and inversely proportional to the microhardness of the material. Knowing the state of the surface of the material (the density of irregularities and the radius of their curvature), one can approximately estimate the area of ​​their contact and the ultimate loads at which the destruction of the surface begins. Comparison of the state of the surface of porcelain and glass-ceramic prostheses obtained different ways, gives grounds to assert that the magnitude and density of the surface roughness of dental crowns is determined by the method of their manufacture. The formation of the surface of porcelain prostheses occurs in the process of sintering polycomponent powders, which include components of different refractoriness. Sharp protrusions are the most refractory components of the material, these areas due to increased refractory, and therefore, high viscosity(during sintering) cannot be leveled by surface tension forces.

The basis for the manufacture of sikor products is a homogeneous glass mass, which excludes the appearance of significant heterogeneities on their surface. However, the powder sintering method assumes uneven surface tension during sintering, which results in the presence of individual protrusions on the surface. Mechanical polishing does not allow to smooth out the roughness due to the fact that the glaze film is opened and the roughness increases.

Thus, glass-ceramic dentures, especially those made by casting (V.N. Kopeikin, I. Yu. Lebedenko, S. V. Anisimova, Yu. F. Titov), ​​in comparison with porcelain prostheses obtained by powder sintering, have a much smoother surface, which does not change during long-term operation due to the fine-crystalline structure of glass-ceramic and the absence of pores in it. Violation of the glazed layer of prostheses that occurs during grinding of glass-ceramic and porcelain prostheses fixed in the mouth sharply increases the surface roughness and, consequently, the coefficient of its friction with the antagonist, which, together with the high hardness of the material, can lead to intense abrasive wear of the hard tissues of the antagonist teeth. . Therefore, in the manufacture of prostheses from ceramic materials, in order to prevent complications in the form of pathological abrasion of antagonistic teeth, it is necessary to carefully align the occlusal contacts at the stage of fitting the prostheses, it is imperative to glaze the surface of ceramic prostheses well without disturbing it after fixation.

Pathological abrasion of teeth may be a consequence of the characteristics of the nature of chewing, in which all teeth or only part of the teeth experience excessive functional load.

In such cases, excessive functional load over time can lead to two types of complications: support apparatus teeth - periodontal or from the hard tissues of the teeth - pathological abrasion of teeth, which often occurs against the background of functional insufficiency of hard tissues, although it can also be observed in teeth with a normal structure and mineralization of enamel and dentin. Overloading of teeth can be focal or generalized.

One of the causes of focal functional overload of teeth is occlusion pathology. In the presence of pathology in the process of chewing in various phases of occlusion, certain groups of teeth experience excessive load and as a consequence, there is a pathological abrasion of the teeth. An example is the abrasion of the palatal surface of the anterior teeth of the upper row and the vestibular surface of the incisors of the lower jaw in patients with a deep blocking bite. common cause pathological abrasion of individual teeth is an anomaly in the position or shape of the tooth, leading to the occurrence of supercontact on this tooth during function.

The type of occlusion can also exacerbate the development of pathological abrasion of teeth resulting from functional inferiority of hard dental tissues or excessive abrasive exposure to various factors. So, with a direct bite, the processes of erasing hard tissues proceed much faster than with other types of bite.

Partial adentia (primary or secondary), especially in the area chewing teeth, leads to functional overload of the remaining teeth. With bilateral loss of chewing teeth, the front teeth experience not only excessive, but also unusual functional load. At the same time, pathological abrasion of the remaining antagonistic teeth is observed.

Medical errors in the prosthetics of defects in the dentition also lead to excessive functional load: the absence of multiple contact of the teeth in all phases of all types of occlusion causes an overload of the row of teeth and their abrasion. Erasing of individual teeth is often observed, antagonizing with teeth having protruding fillings made of composite materials, due to the strong abrasive action inherent in composites.

In orthopedic dentistry, there is currently a large arsenal of materials for the manufacture of dentures. When using them, you should strictly follow the indications and pay attention Special attention the possibility of their combined use.

For example, plastic for fixed prostheses "Sinma" is inferior in hardness to tooth enamel. Therefore, in the manufacture plastic prostheses(bridges with an open chewing surface or removable dentures) in the area of ​​the chewing teeth, the occurrence of functional overload of the anterior teeth due to the erasable plastic is inevitable in the next period after prosthetics. Another example: in the combined manufacture of prostheses from precious metals and plastic antagonists, plastic, due to its inherent high abrasive effect, will lead to rapid wear of crowns made of precious alloys, and, consequently, to functional overload of the opposing natural teeth in the mouth. When assessing abrasive wear, one should take into account not only the hardness of the material, but also the value of its coefficient of friction with the material of the antagonist: the greater the coefficient of friction, the greater the abrasive effect of the material. So, for example, the hardness of Sikor sitall is higher than that of Vitadur porcelain, but its abrasive effect is less, since its coefficient of friction with natural tooth tissues is lower.

One of the causes of generalized pathological abrasion of teeth is considered to be bruxomania, or bruxism, - unconscious (often nocturnal) clenching of the jaws or habitual automatic movements of the lower jaw, accompanied by grinding of teeth. Bruxism is seen in both children and adults. The causes of bruxism are not well understood. Bruxism is believed to be a manifestation neurotic syndrome, is also observed with excessive nervous tension. Bruxism refers to parafunctions, that is, to a group of perverted functions.

The role of functional overload of teeth in the etiology of pathological abrasion of teeth was proved in an animal experiment [Kalamkarov X. A., 1984]. The overload of the anterior teeth was modeled by removing the chewing teeth or by making crowns on the anterior teeth of the lower jaw that increase the bite.

As a result, already after 3 months, a significant abrasion of the cutting edge of the anterior teeth was noted. Histological examination revealed that morphological changes in pathological tooth wear due to functional overload occur in all periodontal tissues.

With pathological abrasion of teeth, in most cases, in response to the loss of hard tissues, the formation of replacement dentin occurs, corresponding to the localization of the worn surface. The amount of replacement dentin varies and is not related to the degree of wear. With massive deposition of replacement dentin, its globular structure is noted. The cavity of the tooth decreases in volume up to complete obliteration.

The configuration of the altered tooth cavity depends on the topography of wear and the degree of damage. Often there is the formation of denticles of various shapes, sizes and degrees of maturity.

There are significant changes in the pulp of pathologically worn teeth (Fig. 85). They are expressed, in particular, as follows:

In the change in vascularization: depletion of the pulp with vessels, sclerosis of the vessels; sometimes, on the contrary, there is increased vascularization, small foci of hemorrhages; in partial or complete vacuolization, atrophy of odontoblasts, a decrease in the number of cellular elements; in net atrophy, sclerosis, pulp hyalinosis.

Rice. 85. Vacuolization of the odontoplast layer with pathological wear. microphoto.

The severity of pulp damage depends on the degree of pathological abrasion of the teeth. In the nervous apparatus of the pulp, changes in the type of irritation are noted: hyperargyrophilia, thickening of the axial cylinders.

Typical for pathological tooth wear during functional overload (more than 80%) is a compensatory increase in the thickness of the cement tissue - hypercementosis (Fig. 86).

In this case, the layering of cement occurs unevenly, the greatest is noted at the top of the root. Not only does the mass of cement increase, but often its structure takes on a layered appearance.

Cementicles are often found. In some patients, destruction of the cementum with its partial exfoliation from the dentin is observed, which can be regarded as osteoclastic resorption of root tissues in response to functional overload.

Changes in the periodontium with pathological abrasion of teeth due to functional overload consist in the uneven width of the periodontal gap along the gingival margin to the root apex. The expansion of the periodontal gap occurs more in the cervical part and at the root apex and directly depends on the degree of functional overload.

Rice. 86. Hypercementosis of the tooth with abrasion. microphoto.

In the middle third of the root, the periodontal fissure is usually narrowed. In all cases, there is a violation of local hemodynamics, edema, hyperemia, and focal infiltration. Often, in response to an excessive functional load in the periodontium of worn teeth, chronic inflammation develops with the formation of granulomas and cystogranulomas, which must be taken into account when examining such patients and choosing a treatment plan (Fig. 87).

Pathological abrasion of teeth leads to a change in the shape of the crown part, which in turn contributes to a change in the direction of the functional load on the tooth and periodontium. In this case, compression and tension zones arise in the latter, which necessarily leads to characteristic pathological changes in the periodontium. In areas of compression, cement resorption, its exfoliation from dentin, replacement with osteocement, osteoclastic resorption of bone tissue, periodontal collagenization are noted. In tension zones, on the contrary, there is a massive layering of cement, along the periphery of which there is deposition of osteocement.

Rice. 87. Resorption of the apex of the tooth root. A granuloma is also visible. microphoto.

Changing the shape of the crown part in case of pathological tooth wear (PSA) increases the functional load on the teeth.

Thus, with pathological tooth abrasion resulting from functional overload, a vicious circle is observed: functional overload leads to pathological tooth abrasion, a change in the shape of crowns, which in turn changes the functional load necessary for chewing food, increasing it, and this is even more contributes to the destruction of hard tissues of teeth and periodontium, aggravating pathological abrasion. Therefore, orthopedic treatment aimed at restoring the normal shape of worn teeth should be considered not symptomatic, but pathogenetic.

Clinical picture

The clinical picture of pathological tooth abrasion is extremely diverse and depends on the degree of damage, topography, prevalence and prescription of the process, its etiology, the presence of concomitant general pathology and lesions of the dentofacial system.

With pathological abrasion of teeth, aesthetic standards are primarily violated due to a change in the anatomical shape of the teeth. In the future, with the progression of the pathological process and a significant shortening of the teeth, chewing and phonetic functions change. In addition, in some patients, even in the initial stages of pathological tooth wear, hyperesthesia of the affected teeth is noted, which disrupts the intake of hot, cold, sweet or sour foods.

To classify the whole variety clinical manifestation pathological abrasion of teeth, forms, types and degree of damage are distinguished. Forms of pathological abrasion of teeth characterize the extent of the pathological process. There are generalized and localized forms.

The generalized form of pathological tooth wear, in turn, may be accompanied by a decrease in occlusal height (Fig. 88).

Types of pathological abrasion of teeth reflect the predominant plane of tooth damage: vertical, horizontal or mixed damage (Fig. 89).

The degree of pathological abrasion of teeth characterizes the depth of the lesion: I degree - the lesion is not more than 1/3 of the height of the crown; II degree - defeat 1/3 - 2/3 of the height of the crown; Grade III - damage to more than 2/3 of the crown of the tooth.

The pathological process can affect the teeth of one or both jaws, on one or both sides. In practice, there are cases of varying degrees of damage to the teeth of one or both jaws. The nature and plane of the lesion may be identical, but may vary. All this determines the diversity of the clinical picture of pathological tooth wear, which becomes much more complicated with partial adentia of one or both jaws.

Rice. 88. Erasure: generalized form.

For correct setting diagnosis and selection of the optimal treatment plan for such a diverse clinical picture pathological abrasion of teeth, it is necessary to carefully examine patients to identify the etiological factors of pathological abrasion of teeth and concomitant pathology. The survey must be carried out in full according to the traditional scheme: 1) interviewing the patient, studying complaints, life history and disease history; 2) external examination; 3) examination of the organs of the oral cavity; palpation of masticatory muscles, temporomandibular joint, etc.; 4) auscultation of the temporomandibular joint; 5) helper methods: study of diagnostic models, targeted radiography of teeth, panoramic radiography teeth and jaws, EDI, tomography, electromyography and electromyotonometry of masticatory muscles.

Complaints of patients can be different and depend on the degree of pathological abrasion of teeth, the topography and extent of the lesion, the duration of the disease, and concomitant pathology.

In the absence of concomitant lesions of the maxillofacial region, patients with pathological abrasion of teeth usually complain of a cosmetic defect due to the progressive loss of hard tissues of the teeth, sometimes hyperesthesia of enamel and dentin, with acid necrosis - a feeling of soreness and roughness of the enamel.

Rice. 89. Types of pathological abrasion.
a - vertical; 6 - horizontal.

Studying the patient's life history, they pay attention to the presence of a similar pathology in other family members, which may indicate a genetic predisposition, congenital functional insufficiency of hard dental tissues.

It should be borne in mind that pathological abrasion of teeth can be observed in several members of the same family and not only as a result of hereditary pathology, but also due to the commonality of nutrition, life, and sometimes occupational hazards. All this can contribute to a decrease in the functional value of hard tissues of teeth and their increased abrasive wear.

When taking an anamnesis, it is necessary to identify concomitant general somatic pathology, congenital dysplasia, endocrinopathies, neurodystrophic disorders, kidney disease, gastrointestinal tract etc. It is necessary to very carefully identify the root cause of erasure. If from the anamnesis and as a result clinical examination it turns out that the pathological abrasion of the teeth arose against the background of a functional insufficiency of the hard tissues of the teeth of endogenous origin, then when choosing the design of the prosthesis, one should prefer those that would minimally overload the supporting teeth. Otherwise, due to congenital (especially) or acquired insufficiency in osteogenesis, resorption of the roots, severe atrophy of bone tissue from the dental alveoli may occur.

Often, in hereditary diseases (marble disease, Frolik's syndrome, etc.), the roots of worn teeth are underdeveloped, the root canals are twisted and obliterated. Therefore, in such cases, indications for pin structures are narrowed. In addition, the clarification in the anamnesis of a hereditary pathology such as Frolik and Lobstein syndromes, Capdepon's syndrome makes it possible to predict with a sufficient degree of probability the prognosis of the state of the dentoalveolar system and the musculoskeletal system as a whole in subsequent generations, since changes in the teeth in Frolik and Lobstein syndromes are inherited as a non-permanent dominant sign, and in Capdepon's syndrome - as a permanent dominant sign.

Finding out the history of this disease, pay attention to the prescription of the occurrence of pathological abrasion of teeth, the nature of its progression, the connection with the prosthetics of the teeth and jaws, the nature and conditions of work and life of the patient.

During an external examination of the patient's face, the configuration of the face, proportionality and symmetry are noted. The height of the lower part of the face is determined in a state of physiological rest and in central occlusion. Carefully study the state of hard tissues of the teeth, establishing the nature, extent, degree of wear. Pay due attention to the condition of the oral mucosa and periodontal teeth to identify concomitant pathology and complications.

Palpation of the masticatory muscles reveals soreness, asymmetry of sensations, swelling of the muscles, their hypertonicity and suggests the presence of parafunctions in the patient. In the future, to clarify the diagnosis, it is necessary to conduct additional studies: electromyography and electromyotonometry of masticatory muscles, consult a neurologist about possible bruxism, carefully ask the patient and his relatives about possible grinding of teeth in a dream. This is necessary for the prevention of complications and the choice of the optimal complex treatment such a group of patients.

Palpation of the region of the temporomandibular joint, as well as auscultation of this region, makes it possible to identify a pathology that is often found in pathological abrasion of teeth, especially in a generalized or localized form, complicated partial edentulous. In these cases, careful analysis of diagnostic models and x-ray examination; frontal and lateral tomograms with closed jaws and at physiological rest.

Electroodontodiagnostics (EOD) is a mandatory diagnostic test for pathological tooth wear, especially grades II and III, as well as when choosing the design of fixed dentures. Often, pathological abrasion of teeth is accompanied by asymptomatic pulp death.

As a result of the deposition of replacement dentin, partial or complete obliteration of the pulp chamber, the electrical excitability of the pulp is reduced. With pathological abrasion of teeth of the 1st degree, accompanied by hyperesthesia of hard tissues, EDI usually does not allow to detect deviations from the norm.

As well as EDI, radiography (aiming and panoramic) is a mandatory diagnostic method that allows you to determine the size and topography of the pulp chamber, topography, direction and degree of obliteration of the root canals, the severity of hypercementosis, the presence of cysts, granulomas in worn teeth that are often found during functional overload of teeth. All this no doubt has great importance for selection right plan treatment.

Careful study of diagnostic models contributes to the correct diagnosis and treatment planning of patients with pathological abrasion of teeth, as well as the control of the course and results of treatment. On diagnostic models, the type, shape and degree of pathological abrasion of teeth, the state of the dentition are specified, and when they are analyzed in the articulator, the nature of the occlusal relationships of the teeth and dentition in various phases of all types of occlusion is specified, which is especially important in the diagnosis of concomitant pathology of the temporomandibular joint and choosing a treatment plan.

Treatment

Restoration of the anatomical shape of worn teeth depends on the degree, type and form of the lesion. Inlays, fillings (mainly on the front teeth), artificial crowns can be used to restore the anatomical shape of the teeth with pathological abrasion of teeth of the 1st degree; II degree - inlays, artificial crowns, clasp prostheses with occlusal linings; III degree - stump crowns, stamped caps with occlusal soldering.

In case of pathological wear of teeth of II and III degrees, conventional stamped crowns cannot be used, since complications associated with trauma to the marginal periodontium by the edge of the crown, deeply advanced into the gum pocket, are possible. Deep advancement of a stamped crown can occur when the crown is cemented to a severely shortened tooth. In addition, trauma to the marginal periodontium is also possible during the use of a crown, when under the action of chewing pressure a thick layer of cement is destroyed between the chewing surface of the worn tooth and the occlusal surface of the crown, and the crown is deeply immersed in the gum pocket. Therefore, if there are indications for the treatment of pathological tooth wear with artificial crowns, several options for their manufacture are possible (Fig. 90, 91): 1) cast crowns; 2) stamped caps with occlusal soldering; 3) stump crowns (stamped or cast crowns) with a preliminary restoration of the height of the tooth crown with a stump tab with a pin.

When choosing a material for crowns, its wear resistance should be taken into account. If the teeth are antagonists with unaffected enamel, metal, metal-ceramic, porcelain crowns can be used. For antagonists with I degree of pathological wear, plastic crowns are preferred, metal crowns stainless steel, precious metal alloys; ceramic and solid-cast prostheses from CCS.

Rice. Fig. 90. Crowns for the treatment of pathological wear, a - frame of a fenestrated crown made of metal; b - stamped cap with holes on chewing surface; c, d — plastic is applied to the crown and cap; e - solid cast frame of the metal-plastic crown.

Rice. 91. Fixed prostheses such as pins and caps with an occlusal cast part to restore the shape of teeth in case of pathological wear.

Counter prosthetics with inlays and (or) crowns using structural materials of the same wear resistance is indicated for co II antagonists - III degree pathological wear.

In case of pathological abrasion of teeth resulting from bruxism and parafunctions, preference should be given to solid metal and metal-plastic (with a metal chewing surface) prostheses made from base metal alloys, as they are more resistant to abrasion. Metal-ceramic prostheses in such patients, it should be used limitedly due to the possible spallation of the coating in case of involuntary non-functional excessive occlusal overload: nightly grinding of teeth, spastic clenching of the jaws, etc.

When choosing a treatment plan for pathological tooth wear complicated by partial adentia (Fig. 92), they are necessarily based on data from EOD and radiological control of supporting teeth. When pathological abrasion of teeth occurs against the background of congenital disorders of amelo- and dentinogenesis, imperfection of the roots of the teeth, their functional inferiority are often observed, which can lead to resorption of the roots of such teeth when used as supports for bridges. Such patients are shown the restoration of worn teeth with artificial crowns or inlays, followed by the manufacture of removable (clasp or plate) prostheses (Fig. 93).

Treatment of pathological tooth wear complicated by a decrease in occlusal height. The treatment is carried out in several stages: 1) restoration of the occlusal height with temporary medical and diagnostic devices; 2) adaptation period; 3) permanent prosthetics.

At the first stage, the restoration of the occlusal height is carried out with the help of plastic mouthguards, tooth-gingival mouthguards, removable lamellar or clasp prostheses with overlapping of the chewing surface of worn teeth. Such restoration can be instantaneous with a decrease in the occlusal height to 10 mm from the height of physiological rest and staged - 5 mm every 1-1Y 2 months with a decrease in the occlusal height by more than 10 mm from the physiological rest (Fig. 94).

To determine the height of the future prosthesis, wax or plastic bases with bite rollers are made, the required “new” position of the lower jaw is determined and fixed in the clinic in a generally accepted way, and x-ray control is mandatory. On radiographs of the temporomandibular joints with closed dentition in a position fixed by wax rollers, there should be a “correct” position of the articular head (on the slope of the articular tubercle), uniform on both sides. Only after that, such a situation is fixed with temporary medical and diagnostic devices-prostheses.

The second stage - an adaptation period of at least 3 weeks - is required for completely addictive the patient to the "new" occlusal height, which occurs due to the restructuring of the myotatic reflex in the chewing muscles and the temporomandibular joint.

Rice. 92. Bridge prosthesis used for pathological wear.
a - soldered frame of the prosthesis; b - the frame is lined with plastic; c — a solid cast frame of the prosthesis (left) and a frame lined with pyroplast (right).

During this period, the patient should be under the dynamic supervision of the attending orthopedic dentist (at least once a week, and if necessary: ​​subjective discomfort, pain, discomfort, inconvenience when using medical diagnostic devices - and more often).

When using non-removable medical diagnostic devices - plastic caps - the adaptation process proceeds faster than when restoring the occlusal height with removable structures, especially plate ones. This is explained not only by the design features of the prostheses, but also by the fact that fixed mouthguards are fixed with cement and patients use them constantly. On the contrary, patients often use removable devices only for a short time of the day, removing them during work, eating, and sleeping. Such use of prosthetic devices should be regarded not only as useless, but as harmful, since it can lead to pathological changes in the temporomandibular joint, to muscular-articular dysfunctions.

Therefore, it is necessary to conduct preliminary explanatory conversations with patients with a warning about possible complications in case of inconsistent use of the medical device and the need for mandatory contact with the attending orthopedic dentist in the event of discomfort in the temporomandibular joint, masticatory muscles, mucous membrane of the prosthetic bed. At the time of fitting the medical and diagnostic apparatus and during control examinations, occlusal contacts are especially carefully verified in all phases of all types of occlusion, the quality of the polishing of the prosthesis is checked, the absence of sharp protrusions and edges that can injure soft tissues.

If, with a simultaneous increase in the occlusal height by 8–10 mm, the patient experiences severe pain that increases during the first week in the area of ​​the temporomandibular joint and (or) masticatory muscles, it is necessary to reduce the height by 2–3 mm until the pain disappears, and then , after 2-3 weeks, re-raise the occlusal height to the required value. Technically, this is easily accomplished by grinding off a layer of plastic on the chewing surface of the medical diagnostic apparatus or by applying an additional layer of fast-hardening plastic.

It should be emphasized that the adaptation period of 2-3 weeks is considered from the moment the last unpleasant sensations in the patient in the area of ​​the temporomandibular joint or masticatory muscles disappear.

Sometimes, due to unpleasant subjective sensations, repeated attempts to increase the occlusal height to the desired optimal level(2 mm below the height of physiological rest) remain unsuccessful. Such patients are made permanent prostheses at the maximum occlusal height to which he was able to adapt. This is usually observed in patients whose occlusal height has decreased more than 10 years ago and irreversible changes have occurred in the temporomandibular joint. The same picture is observed in patients with pathological abrasion of teeth, complicated by disorders of the psycho-emotional sphere, who are overly focused on the nature and degree of their subjective sensations. Orthopedic treatment of pathological tooth wear, complicated by a decrease in occlusal height, is extremely difficult in this category of patients, the prognosis is doubtful, and treatment must be carried out in parallel with treatment by a psychoneurologist.

The third stage of treatment - permanent prosthetics - does not fundamentally differ in the type of dentures used in the treatment of pathological tooth wear. It is important to note only the need to use structural materials that guarantee the stability of the established occlusal height. It is unacceptable to use plastic on the chewing surface of bridges. In removable dentures, it is preferable to use porcelain teeth, cast occlusal linings (Fig. 95). Counter inlays and crowns are used to stabilize the occlusal height.

An important condition for achieving good results permanent prosthetics - the manufacture of prostheses under the control of temporary medical-diagnostic caps. Perhaps a phased production of permanent prostheses. First, prostheses are made for one half of the upper and lower jaws in the region of the chewing teeth, while temporary mouthguards remain fixed in the frontal area and on the opposite half of both jaws.

Rice. 95. Pathological wear; mixed form(s). Clasp prosthesis with an occlusal lining in the group of chewing teeth (b) and metal-ceramic crowns on the anterior group of teeth (c).

When fitting permanent prostheses, temporary mouthguards allow you to accurately set the occlusal height and optimal occlusal contacts in various phases of all types of occlusion to which the patient is adapted. After fixing permanent dentures on one half of the jaws, temporary mouth guards are removed and permanent dentures are made for the rest of the dentition. For the period of manufacture of prostheses, medical and diagnostic mouthguards are temporarily fixed.

Treatment of pathological tooth wear without reducing the occlusal height. Treatment is also carried out in stages. At the first stage, by the method of gradual deocclusion, the area of ​​the dentition with pathological abrasion of teeth and vacant hypertrophy is rebuilt alveolar process, achieving sufficient occlusal space to restore the anatomical shape of worn teeth (Fig. 96). To do this, a plastic mouthguard is made on the teeth that antagonize with the teeth to be "rebuilt". Respect next rule: the sum of the periodontal endurance coefficients of the teeth included in the kappa should be 1.2-1.5 times higher than the sum of the periodontal endurance coefficients of the teeth subject to "restructuring".

Rice. 96. Therapeutic mouth guard made of plastic on the anterior teeth of the lower jaw with localized pathological wear, a — before treatment; b - kappa on the teeth; c — after treatment.

The kappa is made in such a way that in the area of ​​the reconstructed teeth there is a tight planar contact with the kappa, and in the group of separated chewing teeth the gap does not exceed 1 mm (a sheet of writing paper folded in half should pass freely). To control and eliminate possible complications after fixing the mouthguard, the patient is asked to come the next day, and then they are offered to come to the appointment as soon as the patient determines the occurrence of tight contact in the group of disconnected chewing teeth. Previously, the patient must be taught to control the presence of occlusal contact of the teeth by biting a thin strip of writing paper. After contact is reached, the kappa is corrected with a fast-hardening plastic, achieving deocclusion in the group of chewing teeth up to 1 mm, for which layers of a clasp wax plate are laid between the molars. Again appoint an appointment upon reaching a tight contact of separated teeth. Thus, the method of gradual deocclusion achieves the necessary restructuring of the site of vacant hypertrophy of the alveolar process.

The method of gradual deocclusion is applicable in the treatment of a localized form of pathological tooth wear without reducing the occlusal height. In the generalized form of such a pathology, the method of sequential deocclusion is used. It consists in gradual deocclusion sequentially, first in the frontal area, then on one side in the region of the chewing teeth, then on the other. Given the long duration of such a restructuring, the treatment of a generalized form of pathological tooth wear without reducing the occlusal height should be considered the most difficult and time-consuming with a dubious prognosis, since the deocclusion method does not always achieve the desired result. In addition, it is contraindicated in the pathology of the periapical tissues, atrophy of the bone tissue and in the area of ​​teeth subject to "restructuring", diseases of the temporomandibular joint.

The second stage is the restoration of the anatomical shape of worn teeth with one of the previously considered types of prostheses. The prognosis for the treatment of pathological tooth wear is generally favorable. The results of treatment are better than the streets of young and middle age with an initial degree of abrasion. However, it is necessary to note the possibility of relapses in patients with pathological tooth wear against the background of bruxism and parafunctions, which confirms the idea that only orthopedic interventions are insufficient without appropriate neuropsychiatric corrections.

All patients with pathological abrasion of teeth should be on dispensary observation.

Orthopedic dentistry
Edited by Corresponding Member of the Russian Academy of Medical Sciences, Professor V.N. Kopeikin, Professor M.Z. Mirgazizov

Increased abrasion of teeth is a pathology that requires urgent treatment. Every year this disease "gets younger", affecting people under 30 years old. The intensive decrease in hard tissues leads not only to aesthetic problems, but also functional disorders dental apparatus. Why does the disease develop, what methods of therapy does modern dentistry offer?

The difference between natural and pathological tooth wear

Throughout life, human enamel gradually grinds off - this is a normal process. Very slowly, even in children, it is erased - this is how the teeth adapt to the chewing load. Normally, the thickness of the enamel decreases only in the area of ​​​​contact of the teeth, while the dentin is not affected. Normal is the gradual loss of hard layers of the tooth by 0.034–0.042 mm per year.

In humans, by the age of 30, the front teeth are slightly erased, and the masticatory tubercles acquire a smoothed outline. By the age of 50, the enamel on the contact surfaces disappears almost completely without damage to other tissues. In older people, dentin begins to wear down. If the described process accelerates, this indicates pathological tooth wear.

The pathology is indicated by a decrease in the thickness of the hard layers of the elements of the dentition in young people - usually the erasing process begins at the age of 25-30. In humans, the height of the crown slowly decreases, its shape changes, the bite is disturbed, and the sensitivity of units increases.

This condition can come on suddenly. Studies show that 12% of the world's population is affected by this pathological process, and men suffer from the disease in more than 60% of cases.

Classification of pathology

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There is a classification of the process of tooth wear, compiled depending on the type and complexity of the disease. There are 4 degrees of abrasion:

• 1 - decrease in the thickness of the upper layer of enamel;
• 2 - complete erasure of the hard layer of the unit up to the dentin;
• 3 - the crown is reduced by more than half, the tooth cavity becomes visible;
• 4 - the unit is erased to the ground.

Depending on the complexity of the course of the disease, there are:

• local wear - only one area of ​​​​the dentition is affected by pathology;
• generalized - the process extends to both jaws, however, the degree of damage to units may vary.

There is also a classification that determines the plane under which the teeth have undergone abrasion:

• horizontal - in humans, the height of the crowns decreases almost evenly;
• vertical - the front surface of the lower and the back are subjected to grinding upper canines and incisors (occurs in case of malocclusion);
• mixed - teeth are destroyed in both planes.

Tooth abrasion occurs in various forms, and the degree of damage to each may be different. However, if the dentin is affected and the nerve dies, the pathological process is irreversible.

Using the classification, the doctor determines the percentage of enamel loss and the rate at which the disease progresses.

Causes and symptoms of increased abrasion

To understand why a patient develops a pathology, the dentist must ask him about his lifestyle and learn about diseases in the family. Most dangerous reasons increased abrasion of teeth are hereditary factors:

• Congenital disorder of the formation of hard tissues. The disease develops due to a lack of microelements for the development of the fetus during pregnancy in the mother's body, as well as their deficiency in the first year of the baby's life.
• Marble disease, osteogenesis and other inherited ailments.
• Diseases associated with impaired functioning of the thyroid gland and problems with the absorption of calcium by the body.

Also, increased abrasion of teeth is provoked by other reasons:

• broken bite;
• nighttime teeth grinding (bruxism);
• loss of several teeth;
• frequent intoxication of the body due to regular drinking and smoking;
• incorrectly performed prosthetics or unsuccessfully installed filling;
• softening of the enamel in certain diseases;
• frequent use of foods containing acid (juices, candies, etc.);
• malnutrition, including the constant use of sweet, starchy and hard foods;
• bad habits - chewing the tips of pens, toothpicks and other objects;
• taking certain drugs that lead to the destruction of the hard layers of the tooth;
• work associated with being in hazardous production.

With pathological abrasion in humans, the sensitivity of enamel to temperature changes increases. Associated features diseases:

• sharp, strong pain, often appearing at night;
• increase in interdental spaces;
• the presence of caries;
• reduction in the height of the crowns;
• mucosal injury due to the formation of chips and sharp edges of the teeth;
• change in bite;
• frequent biting of the cheek;
• sensation of roughness of the teeth;
• a feeling of sticking of the jaws when they are closed;
• enamel discoloration.

Treatment of increased tooth wear

If the patient's teeth have worn off, treatment is carried out taking into account the severity of the process. The efforts of doctors are aimed at eliminating the causes of abrasion: the fight against bad habits, the replacement of prostheses, bite correction, etc.

Pathological abrasion of teeth at an early stage is treated with the use of remineralizing therapy - the patient is prescribed vitamin complexes, make applications with fluorine-containing drugs, carry out electrophoresis. In the presence of sharp edges of the teeth, they are ground off; in case of bruxism, the use of a night guard is prescribed. However, most often patients go to the doctor when the teeth have already worn out significantly. In this case, the treatment is aimed at restoring the units.

Treatment of pathological abrasion of incisors, canines or chewing teeth is performed using various designs. Used in dentistry:

• Crowns. To restore significantly destroyed units, cermets are used. If a structure of increased strength is required, products made of metal or zirconium dioxide are installed. The restored tooth takes on part of the load, removing it from the neighboring ones.
• Ceramic inlays and veneers. If the wear of the front teeth is very pronounced and has reached the dentin, the units are restored with thin plates (we recommend reading:). They are highly aesthetic and natural looking.
• Cult tabs. This technique is suitable for significant abrasion of teeth - a pin is installed in the root canal, around which a crown is built up.
• Prosthetics with implants. When the units are destroyed to the very foundation in a patient with a problem of increased erasure, they are replaced with an artificial material. Festered roots are removed, and a pin is installed in place of the lost element, on which a crown is put on. The restoration process can take up to six months.

Treatment of pathological abrasion of teeth of stages 3 and 4 necessarily begins with the restoration of the bite - the installation of crowns at the initial stage of therapy is prohibited, since they can cause the formation malocclusion. Subsequently, the orthopedist makes and puts prostheses from the same materials (we recommend reading:). Violation of this rule may lead to the need to re-correct the bite.

If the cause of the problem is an increased load on the units, experts recommend installing strong prostheses made of metal or zirconium dioxide (see also:). Brittle ceramics, cermets or metal-plastics are not used.

Regardless of the chosen method of restoring units in case of tooth abrasion, doctors recommend using a mouthguard to reduce the load on the units. The design allows the muscles to get used to the new position of the teeth.

Prevention measures

To prevent abrasion and change in the shape of the teeth, you need to visit the dentist every six months - this will allow you to identify the problem in time. Apart from preventive examination necessary:

• cure bruxism and correct bite;
• to refuse from bad habits;
• to restore the removed and destroyed units in time;
• eat properly;
• use vitamin and mineral complexes;
• in hazardous production, protect teeth with special devices.