If teeth are worn out. Classification and symptoms of pathological abrasion of teeth - treatment and prevention of increased grinding. Why do teeth wear out

Increased tooth wear pathological condition associated with intense loss of enamel in one or more teeth. In complicated cases, the loss of hard tissues is noted on all teeth in the row. The intensity of tissue deficiency depends on age category. AT young age such a process rarely begins, but after 30 years it is observed in almost 18% of men and 16% of women.

Increased abrasion of teeth in old age is observed mainly in men. More often, premolars and upper anterior teeth are involved in this process.

Peculiarities

The pathology is based on many factors. In some cases, they provoke a significant loss of enamel on all teeth. The first examination is carried out at the dentist. Further investigations and collection of complaints are assigned. Often this leads to the fact that the patient goes to one doctor, and another specialist continues to observe him.

The reasons

1. Increased load on healthy organs chewing due to the loss of diseased teeth.
2. Incorrectly fitted dentures.
3. Bruxism.
4. Abnormal bite.
5. Increased softness of dental tissue.
6. Harmful working conditions.
7. The use of especially hard foods (cracking seeds and nuts with teeth).

Level bite . With this structure of the dentition, the surface of the lateral and edge of the cutting teeth is gradually erased. By the age of 40, 50% loss of enamel can be observed. The more the enamel is erased, the faster the destructive process acts. According to statistics, middle-aged people are in no hurry to correct their bite. In old age, refusal of treatment leads to an unaesthetic appearance of the teeth.

If in youth some teeth were removed and they were not restored, then the load was distributed to the front row. So there is a gradual erasure of fangs and incisors.

Men and women working in production with organic and inorganic acids suffer from pathology after only two years of work. Deviation is also observed in persons who are constantly in contact with mechanical particles in the air. The process stops if the working conditions change.

Typically: Loss of tooth enamel occurs when chronic diseases. It can be endocrine disorders, fluorosis or genetic changes in the enamel.

What happens in pathology

AT initial development disease, worn tissues are replaced by dentin. Visually, its intense deposition is observed. Gradually there is a blockage of the channels, the lower edge of the part completely disappears. loose connective tissue changes its properties.

The cells lining the cavity of the tooth crown are significantly reduced. They accumulate fluid. Gradually, the dystrophic process leads to complete atrophy of the hard tissue. The last degrees of enamel loss (3 and 4) are characterized by the formation of replacement dentin without reversible processes.

Classification

Increased abrasion of teeth is divided into several types. They have been described and characterized by various specialists.

According to Bracco (common table with 4 degrees of erasure)

1. Loss of enamel on cutting bumps and edges.
2. The tubercles are completely erased by a third of the crown, and the dentin is exposed.
3. The crown height is reduced by almost 70%.
4. The process extends to the neck of the tooth.

According to Grozovsky (three clinical forms)

1. Horizontal
2. vertical
3. mixed

According to Courland, there are two degrees of enamel abrasion - localized and generalized.

1 degree- affects the enamel and a small part of the dentin.

2 degree- abrasion occurs in the border of the main dentin, the tooth cavity is not translucent.

3 degree- the cavity of the tooth is translucent, the tooth is erased to the replacement dentin.

4 degree- the entire crown of the tooth is erased.

By Bushan

The classification of enamel loss includes the stage of development, the depth of the lesion, the extent, dysfunction and the plane of the tooth. This table shows a clear clinical picture. It helps in diagnosing and calculating the level of atrophy.

The depth of the lesion has 4 degrees. In the first stage, the dentin is exposed and shortened by 30%. Gradually, this figure increases and reaches 80%.

Stages of development

The first degree is called physiological. In this stage, destruction is observed only within the surface of the enamel. At the second level, the enamel and a partial layer of dentin are erased. The third stage has high level dentin lesions.

According to Moldovanov

it modern classification based on years of research. According to the observation of scientists, it was found that the loss of hard tooth tissue during the physiological process of abrasion is up to 0.042 mm per year. Erasure of the surface of the teeth within the dentinal border refers to natural process(in people over 50).

Physiological norms of erasure

1. The incisors are ground down and the tubercles of the molars and premolars are smoothed out (up to 30 years).
2. Abraded single teeth or the entire row to the border of the enamel (up to 50 years).
3. The tooth decreases along the enamel-dentin border, the dentin is partially affected (from 50 years).

Abrasion of milk teeth

By the age of 4, abrasion of the tips of the incisors, canines and molars occurs. At the age of 6, there is abrasion of the enamel within the normal range, but sometimes a point opening of the dentinal border also appears. After 6 years, the wear of the dentin layer is noted, then the change of teeth to molars begins.

There are several types of form erasure. There are horizontal, vertical, faceted, patterned, stepped and mixed grinding of enamel and dentin.

Symptoms

The dentin is gradually exposed, and grinding occurs more intensively, since this tissue has a soft structure. The edges of the teeth become sharp, and this can injure inner part mouth and tongue. If treatment is refused, the abrasion of the teeth progresses rapidly, they become short. The lower third of the face is visually reduced, folds appear near the corners of the mouth. Pathology affects the temporomandibular joint, it appears pain. This may affect hearing acuity.

AT initial stage when eating cold or hot foods, discomfort is observed. The person has a feeling that the tooth is pierced by current. Gradually there is a reaction to acidic foods. When the process is running, the reaction occurs even with the slightest exposure to a chemical or mechanical stimulus.

In complicated cases, the incisors are worn down to the neck. A tooth cavity is visible through the dentin, but it is not exposed or opened. This is prevented by the developed replacement dentin. After the development of a deep bite, the worn surface of the incisors below comes into contact with the palatine part of the teeth in the upper jaw. Constant friction leads to accelerated grinding of the enamel.

Constant overload gradually leads to displacement of teeth and destruction bone tissue. Interdental septa are involved in the process. About 15% of cases of tooth abrasion are recorded when wearing incorrectly selected dentures. Brackets in prostheses provoke grinding of enamel and dentin at the very neck.

When working with acids of a permanent nature, a uniform abrasion of the entire dentition is found. Sharp edges and chips are not observed. The impact of aggressive substances makes the surface of the tooth matte, microbial and stone deposits are not formed. During examination, exposed dentin is visible. It has a smooth and dense texture. From exposure to acid, a feeling of soreness on the teeth appears. Subsequently, pain sensations appear on the surface of the enamel and in the inner part, the natural chewing process. If air gets on the tooth, a change in its color becomes noticeable.

Diagnosis

Important: Increased abrasion of the teeth is not treatable until the cause of its occurrence is determined. To do this, the doctor prescribes full examination, are held various tests. Complaints and disease progression are taken into account.

AT dental office a thorough visual inspection is carried out. The percentage of enamel loss is determined, as well as the rate of progression of the pathology. For each case, an individual treatment is developed. In some cases, the temporomandibular joint is examined, the functionality of the muscles involved in chewing. It is important to determine the condition of the periodontium and teeth.

Inspection

Hard tissue loss can occur in any tooth. The most common abrasion options are where there is contact between the lower and upper teeth in the bite. It is in these places that persistent destruction is observed. Such processes have not yet been fully studied in the dental field, but with right approach there is a way to eliminate them. Defects near the neck of the tooth vary in appearance and surface structure.

What information does the doctor repel?

1. The presence or absence of pain in the patient.
2. Does the amount of worn tissue affect the functionality of the dentition.
3. Whether there are serious aesthetic violations.

Some symptoms are combined with each other or are complicated additional manifestations. It is important for the patient to list all the sensations that he experiences at rest and during the work of the jaws. Does sensitivity appear under mechanical influences?

The dentist takes x-rays before restorative treatment. Sometimes an MRI is required to determine the condition of the bone tissue. During the diagnosis, it is recommended to list all drugs that are taken systemically. Some serious medicines contain substances that delay the absorption of calcium.

Treatment

If the dentist offers dental restoration and enamel extension, you should think about such an offer. The cost of such a procedure can be high if the grinding is subjected to a large number of teeth. Refusal of treatment can lead to serious problems related to food intake and social adjustment.

Important to know: Usually the dentist discusses the risks of treatment, prognosis and demonstrates models of future teeth.

In most cases, when erasing teeth, it is not a conservative approach that is provided, but a correction and rehabilitation treatment. Both direct and indirect restoration techniques are used. There are many methods, so the doctor describes them all, coordinating with the patient.

Carious lesions and loss of enamel on single teeth can be restored using technology. Compared to other types of restoration, it is the simplest and most gentle. Applies composite material, amalgam, cement with ions and other substances. Most patients receive a cast gold inlay. The choice of material depends on the financial capabilities of the patient and how important aesthetics are to him.

Crowns

Metal-ceramic is used in dentistry to correct significant disorders. The purpose of the restorative procedure is to cover the affected tooth with a crown. It allows you to significantly reduce the load. The type of material depends on the clinical picture. Durability is distinguished by cast gold crowns or solid ceramics or zirconium dioxide.

Stump tabs

With a significant destruction of the teeth, the technique of installing stump tabs is used. During the procedure, one of the root canals is expanded, into which a pin is inserted. The patient and the dentist significantly saves the time needed for the restoration of the tooth.

Regardless of the type of restoration chosen, the dentist recommends using a special mouthguard. It reduces stress on teeth different times days. For it to work effectively, its setting must be perfectly balanced, regardless of the position of the jaw.

Microprosthetics

Modern technology for the restoration of an worn tooth has a high aesthetic effect. For restoration, ceramic veneers and inlays are used. They are manufactured and tested in special dental laboratories. Such material has a high naturalness. Ceramic inlays used where filling does not help. For example, if the loss of dentin is high.

Root restoration

After examining the oral cavity, the doctor evaluates the condition of all teeth. In addition to worn surfaces, festering roots may be detected, which should be removed. Such teeth are subjected to complete extraction and replacement with artificial material.

The technique is associated with great difficulties for both the doctor and the patient. Extraction of teeth and their complete restoration can take up to 6 months. The dentist calculates the forecasts, takes into account contraindications to the procedure. Mandatory before complicated operation a coagulogram is given. It shows the level of coagulation.

During the operation, an implant is placed on which a new crown is made. Implants are an indispensable thing when there are cases of complete grinding of teeth and rotting of the roots.

Other features

At pathological stitching teeth, a large difference can be found between the height of the lower facial part and the line of closure of the jaws. To correct this deficiency, a technique is used to increase the interalveolar height. Removable mouth guards are used by the dentist. The patient is then followed up. Within 3 weeks, he should not show other pathologies. Be sure to monitor the condition of the temporomandibular joint. If during the observation there are complaints of pain in the joint, then the specialist adjusts the height. After a while, he again raises the cap to the required level.

Treatment of tooth wear with a violation of the height of 8 mm is carried out in several stages. The reaction of the muscles in the jaw system is controlled when the position of the joints changes. Special bite plates are used. The procedure lasts several weeks, during which the movement of the jaw is monitored using X-rays.

Increased loss of tooth enamel can be prevented.

1. Every six months, upon occurrence unpleasant symptoms in the teeth, it is recommended to visit the dentist. He will monitor the pathological condition. At an early stage of the pathology, sparing methods of treatment can be used. They will cost much less than restoration with complete tooth wear.
2. Constant and complete hygiene will ensure independent control of the oral cavity. Teeth are brushed twice a day. Every week it is recommended to examine the teeth and notice any changes - the appearance of spots, jagged edges, cracks or chips.
3. In case of high tooth decay, the proposed treatment should not be abandoned. This approach to one's own health can lead to loss of masticatory organs and difficulty in eating.

Pathological abrasion of teeth - video

Erasure is the process of loss of hard tissues of the teeth. Erasure of teeth occurs both in a temporary bite and in a permanent one; both occlusal surfaces and proximal ones; both at low speed and at high speed. Depending on the severity of such a process, first of all, physiological and pathological abrasion is distinguished.

Physiological wear of teeth

Physiological abrasion of teeth is adaptive in nature and occurs as a result of regular contact between the teeth of antagonists. The process begins from the moment the teeth enter the occlusal relationship and, being slow, continues throughout life. The adaptive moment is that the teeth adapt to various movements of the lower jaw, causing the smoothness of its movements, reduces the load on the periodontium and improves the integrity of the dentition.

Due to the impact of contact points of antagonizing teeth on each other, areas are formed in these places that increase the contact (or chewing) surface of the teeth, facilitate the sliding of these teeth, reduce the range of motion of the lower jaw and reduce the load on the temporomandibular joint.

Functions of periodontium with the course of a person's life gradually decrease. This is due to a decrease in the trophic abilities of the neurovascular component of the periodontium, due to which there is a gradual atrophy of the alveolar bone, a decrease in the elasticity of the fibers and a change in the ratio between the intra- and extra-osseous parts of the tooth. The tooth in the hole is a lever, and the larger its extraosseous part, the more strong impact transfers this tooth to periodontal tissues. Considering that there is a gradual decrease in the bone part of the periodontium, the process should be aggravated over the years, even in a person who does not have any pathological changes in the periodontium. But this does not normally happen. And it does not occur due to the fact that the physiological erasure of hard tissues of the teeth reduces the height of the extraosseous part of the tooth. Due to this, the ratio of intra- and extraosseous parts of the tooth remains constant, and the load on the periodontium is adequate for age.

In addition to the occlusal surfaces, the proximal surfaces of the teeth are also subject to natural abrasion. Interdental papillae also undergo atrophy and a decrease in their height over time. But due to the transition of point contact between the teeth to the planar one, an increase in the area of ​​​​this site and the approach of the lower edge of the site to the gum, no gaps are formed between the teeth and the gum. This allows the body to carry out adequate self-cleaning of the oral cavity and preserves natural look teeth. Also, an increase in the contact surface increases stability in the dentition, and its shortening is compensated by the medial displacement of the teeth.

Thus, we can make a well-founded conclusion that physiological abrasion is interdependent with the state of human health, an indispensable property of the human masticatory apparatus, contributing to the preservation of its functional and morphological integrity.

Pathological tooth wear

Pathological abrasion of teeth or, as it is also called, increased abrasion appears when tooth abrasion occurs according to a scenario different from physiological abrasion. With pathological abrasion, the process ceases to be slow, other surfaces of the teeth are abraded, and, in addition to enamel, dentin is involved in the abrasion, and, accordingly, the tooth pulp. Very often, pathological abrasion is accompanied by discomfort in the patient and the appearance of corresponding complaints in him, which almost never occurs in the natural process.

At the moment when the abrasion goes into a decompensated state, the height of the lower third of the face gradually decreases. This process is accompanied by dystrophic disorders in the temporomandibular joint, the appearance of pain in it and in chewing muscles ah, decreased chewing function. Outwardly, this is manifested by the severity of the nasolabial and chin folds, a decrease in the lower third of the face, the extension of the chin, and the person acquires the so-called senile facial expression.

Further, due to the mixing of the lower jaw upwards, its displacement also occurs backwards. In this case, the respiratory function also suffers. The volume of the oropharynx decreases due to the distal displacement of the jaw, and, accordingly, the ability to pass the required volume of air. A person reflexively begins to stoop, dystrophic disorders occur in the spine, and, accordingly, primarily in the musculoskeletal and nervous systems of a person, as well as in the digestive, respiratory, cardiovascular and others.

According to various estimates, due to a violation of the functions and condition of the masticatory apparatus and the changes described above, a decrease in human life expectancy can occur by 15 years or more. Against this background, smoking becomes a harmless entertainment.

Causes of pathological abrasion of teeth

The causes of pathological abrasion of teeth are very diverse. All of them can be combined into the following groups.

1. Functional inferiority of hard tissues of teeth caused by a decrease in quality and quantitative characteristics enamel and dentin. In this case, the process can be:

• Hereditary (eg Capdepon-Stenton Syndrome);
• Congenital (violations of amelo- and dentinogenesis);
• Acquired (metabolic disorders various etiologies, as well as dysfunctions of the endocrine, vascular, nervous and other systems)

Resistance to abrasion in teeth depends on the processes of calcification of hard tissues of the tooth in the pre- and posteruptive periods. The leading role in the processes of mineralization is occupied by the neurohumoral regulation of the body. Functionality is especially important parathyroid glands responsible for the balance of calcium and potassium in the body.

Capdepon-Stenton Syndrome

Amelo- and dentinogenesis disorders

1. Functional overload of teeth which can occur when:

• Partial loss of teeth;
• Parafunctions (eg bruxism);
• Hypertonic masticatory muscles of various origins;
• Chronic dental trauma;
• malocclusion;

Pathology can be caused or aggravated in cases where there are defects in the dentition and parafunction of the masticatory muscles. Missing teeth impose their functions on the remaining teeth, and, accordingly, on their periodontium, causing its functional overload. Due to this, the adaptive capabilities of the supporting apparatus of the tooth are reduced, which are not able to compensate for the decrease in the height of the lower third of the face. With pathological abrasion, deposition of secondary cement occurs on the surface of the tooth root, restructuring of the alveoli in the bone tissue and deformation of the periodontal gap.

Along with this, a decrease in height may be accompanied by parafunctions of the masticatory muscles, manifested in the form of bruxism, hypertonicity, etc. Reducing the height will certainly lead to dystrophic changes in the temporomandibular joint. Since these processes are interconnected, the so-called " vicious circle when each of its elements exacerbates the other and the whole process as a whole. In this case, the establishment of causal relationships and the creation of plans for prevention and treatment becomes very difficult.

1. Occupational hazards may occur in production with the release of acids, alkalis and other substances, taking certain medications, etc. For example, acids reduce quality characteristics enamel and dentine, and fine dust is the most common abrasive, which, in combination with adequate dental system becomes aggressive, accelerating the processes of physiological erasure.

Same reason increased erasure iatrogenic factors, such as the high hardness of some ceramic masses during prosthetics and poor-quality polishing of restorations, can become. Even in cases where the hardness of materials does not exceed the hardness of tooth tissues, their aggressive surface is incomparable with the endurance of enamel, and even more so of tooth dentin.

Classification of pathological abrasion of teeth

If distinguish physiological process From the pathological to the doctor is often not difficult, then the manifestations of pathological abrasion are very diverse and need to be classified and specified in each case. Therefore, the classification of pathological abrasion of teeth is as follows:

1. By stage(M.R. Bushan):

• Physiological - within the enamel;
• Transitional - within the enamel with partial involvement of dentin;
• Pathological - within the dentin.

Physiological abrasion always occurs within the dentin, however, at a young age, increased abrasion of only the enamel, together with the etiological factor, can be diagnosed by a doctor. Erasure of dentin is hallmark pathological wear. Dentinal involvement can cause hypersensitivity and pulpal changes such as replacement dentin deposits, narrowing of the root canal lumen to obstruction and pulp atrophy, and formation of calcifications (denticles) in the tooth cavity.

1. By degree(M.R. Bushan):

• I - wear on 1/3 of the length of the tooth crown;
• II - wear by 2/3 of the length of the tooth crown;
• III - wear of the tooth crown by more than 2/3.

In the absence of other factors contributing to periodontal disease, pathological abrasion is rarely accompanied by changes in the supporting apparatus of the tooth. This is due to a decrease in the extraosseous part of the tooth and a decrease in the length of the lever, which reduces the load on the periodontium when the load is on the teeth.

1. By shape(A.L. Grozovsky):

• horizontal;
• vertical;
• Mixed.

With the horizontal form of abrasion, there is a decrease in the hard tissues of the teeth in a horizontal plane with the formation of horizontal abrasion facets. The process most often occurs both on the lower and upper jaw. The vertical type of abrasion is most characteristic and obvious on the frontal group of teeth: on the palatal surface of the upper frontal teeth and the labial surface of the antagonists, which is determined by occlusal relationships. However, with, for example, a progenic ratio of the jaws and dentitions, wear facets on the upper frontal teeth are observed from the labial side and from the lingual side of the antagonists.

Forms of increased tooth wear: a - horizontal; b - vertical; c - mixed

1. By degree of compensation(E.I. Gavrilov):

• Compensated - without reducing the height of the lower third of the face;
• Decompensated - with a decrease in the height of the lower third of the face;

The dentoalveolar system has relatively high compensatory capabilities. Following the loss of hard tissues of the tooth, restructuring occurs alveolar process jaws and displacement of teeth in the area of ​​the defect or the area of ​​the absence of occlusal relationships. The so-called dento-alvelar elongation, or the Popov-Godon phenomenon. Depending on the degree of such restructuring, pathological tooth wear is differentiated into compensated, when the displacement of the teeth prevents a decrease in the height of the lower third of the face, and decompensated, when compensatory changes are not able to completely eliminate the defect or are completely absent.

1. By length(V.Yu. Kurlyandsky):

• Localized - increased abrasion of individual teeth or a group of teeth;
• Generalized.

Localized abrasion is more often observed in the frontal dentition, for example, with a deep bite. This type of abrasion is also locally compensated by the body due to local hypertrophy of the alveolar process. In this case, the fulcrum of the height of the lower third of the face attributable to chewing teeth, remain intact, without disturbing the occlusal relationship and the position of the elements of the temporomandibular joint.

In the generalized form of the process, the crowns of all teeth are captured, with a violation of the bite height. In this case, the degree of compensation depends on individual features organism.

The article was written by N.A. Sokolov. Please, when copying the material, do not forget to indicate the link to the current page.

Teeth Wear updated: February 25, 2018 by: Valeria Zelinskaya

Physiological and increased abrasion of natural teeth.

I. Human teeth are an organ that performs the primary mechanical processing of food. Main function teeth identified morphological features their tissues. The crown part of them consists of enamel - the most durable mechanical tissue. withstanding great pressure when chewed, the enamel, however, has considerable fragility, and resists sudden loads in the form of a blow. The latter lead to spalling of the enamel and exposure of the dentin.

The thickness of the enamel layer is not constant: at the neck of the tooth it barely reaches 0.01 mm, at the equator - 1.0-1.5, in the region, the bottom of the fissures - 0.1-1.5, at the cutting edge of unworn teeth - 1.7 , on the hillocks - 3.5 mm. The specific heat capacity of the enamel is 0.23, the thermal conductivity is low (Ktp is 10.5-10 -4). Outside, the enamel is covered with a very dense and resistant to acids and alkalis film with a thickness of 3-10 microns, which at the neck of the tooth is connected to the epithelium of the gum mucosa, being, as it were, its continuation. Shortly after teething, the enamel film wears off, especially on contact surfaces. Structural element enamel is an enamel prism. It is formed in the process of tooth development from adamantoblasts - cells of the inner epithelium of the enamel organ.

With age, the macro- and microstructure of the teeth change. Chewing tubercles, cutting edges and contact surfaces of teeth, both milk and permanent, undergo physiological abrasion. Contact points are subjected to erasure, subsequently turning into contact pads. The abrasion of the contact surfaces causes the teeth to move while maintaining contacts between them, which prevents food from entering the interdental spaces and injuring the interdental tissues. Physiological abrasion of teeth is a functional adaptive response, as it promotes free and smoother sliding of the dentition, as a result of which the overload of individual groups of teeth is eliminated. The layer of hard tissues of the teeth, lost as a result of abrasion, increases with age.

Thus, the physiological abrasion of teeth is understood as a compensated, slowly proceeding process of loss of the enamel cover of the teeth, which does not pass to the dentin layer. Age-related changes in the degree of tooth wear are evaluated in points.

No wear (0 points) - up to 16 years;

Smoothness of bumps (1 point) - 16-20 years;

The appearance of dentin on the tubercles and the cutting edge (2 points) - 20-30 years;

Abrasion of the chewing surface, in which the enamel is preserved within the furrows (3 points) - 30-50 years;

Complete wear of the enamel (4 points) - 50-60 years;

Missing half of the crown (5 points) - 60-70 years;

Complete erasure of the crown to the neck of the tooth (6 points) - older than 70 years.

Age abrasion depends on the belonging of the tooth to a particular class. At age characteristic the degree of tooth wear also takes into account the individual typological feature of chewing and increased wear on the functionally dominant side of chewing. Tooth abrasion is due to many reasons, and the degree of its severity varies widely.

However, it must be remembered that as a result of increased load on the teeth, increased abrasion of hard tissues does not always occur. Often this leads to pathological destructive changes in periodontal and pulp tissues. As a result of these pathological changes, the teeth acquire mobility, and hard tissues(enamel and dentin) are subject not only to increased abrasion, but also to the cessation of their physiological abrasion. This phenomenon is called delayed erasure.

Increased abrasion of teeth is characterized not only by the rapid progressive loss of enamel to the transition of the enamel-dentin border. It may be due to a violation of the histogenesis of hard tissues (enamel and dentin), which is expressed in their inferior calcification. As a result of a violation of the process of calcification, an inferior structure of the hard tissues of the teeth is formed, which is not able to perceive a significant occlusal load and is prone to intense increased abrasion.

Increased abrasion teeth is a progressive (decompensated) process of loss of hard tissues of the teeth with the transition of the enamel-dentin border, which is accompanied by a complex of aesthetic, functional and morphological changes in the dental and periodontal tissues, masticatory muscles and temporomandibular joints. Erasure of teeth occurs under the influence of various local and common factors. A significant influence on the development of increased tooth wear is exerted by endogenous and exogenous etiological factors. It should be noted metabolic and histogenesis disorders, occlusion features, incisal overlap depth, loss of lateral teeth, the occurrence of traumatic nodes due to the concentration of masticatory pressure, irrational prosthetics, functional disorders central nervous system (parafunctions), the presence of dento-jaw anomalies, the impact of occupational hazards.

Table 1

II. Tooth wear (in points) depending on age

table 2

III. Etiology and pathogenesis of increased abrasion of natural teeth

A.L. Grozovsky (1946) identifies three clinical forms increased abrasion of teeth: horizontal, vertical, mixed.

According to the length of the pathological process, V.Yu. Kurlyandsky (1962) distinguishes between localized and generalized forms of increased abrasion.

Most fully reflects the clinical picture of tooth wear, the classification proposed by M.G. Bushan (1979). It includes various clinical aspects of a functional and morphological nature: stage of development, depth, extent, plane of the lesion and functional disorders.

Pathological abrasion is the loss of hard dental tissues: enamel and dentin. Most often, the occlusal (chewing) surface is erased, less often - the cervical and palatine areas. The defect can extend both to one chewing unit and to the entire row. Treatment of the disease is aimed at restoring aesthetic and physiological functions.

Throughout life, human enamel is constantly erased: there is a gradual smoothing of the tubercles and teeth. This process intensifies after 30 years. However, normally, the loss of hard tissues should not exceed 0.034 - 0.042 mm per year. When similar condition observed in children, young people, or enamel and dentin are destroyed too quickly, they speak of pathological tooth abrasion.

According to statistics, pathology occurs in 12% of patients. And more often in men (62.5%) than in women (22.7%). Among the main causes are considered mechanical factors of damage. The disease develops due to:

Important! Increased tooth wear also develops with intense physical activity or hard work. Athletes, builders, loaders while lifting weights can strongly clench their jaws, which leads to tissue loss.

Symptoms

Patients usually apply for medical help on the late stages the development of pathological abrasion, when there is a significant loss of bone tissue. The reason for the visit is the loss of aesthetic and chewing functions.

At the initial stage, hyperesthesia is observed - increased sensitivity of the enamel. Changes start later appearance teeth. At first, it is slightly noticeable, but as the pathology develops, it progresses.

As a rule, patients find the problem when the destruction reaches the inner layer - the dentin. Due to its lower strength than enamel, crowns are chipped, sharp corners, jagged. In some cases, abrasion helps to reduce carious processes at the initial stage.

At the initial stage, there is an increased sensitivity of the enamel.

Subsequently, speech is impaired. In particular, difficulties are noted when pronouncing the sounds "z" and "s". On the deep stage there is a change in the outlines of the lower third of the face, facial expressions and symmetry, deformation of the temporomandibular joint, malocclusion, mobility of incisors, canines or molars.

Important! One of the signs of the disease is difficulty in chewing food and the formation of wrinkles in the corners of the mouth.

Classification

Increased abrasion of teeth is classified according to several criteria:

1. Degrees of hard tissue loss:

• Stage 1 - abrasion within the cutting surface of the incisors and canines and masticatory tubercles of the molars;
• Stage 2 - the dentin layer is exposed, the crown is erased by a third;
• Stage 3 - up to 2/3 of the tissues are lost;
• Stage 4 - loss of bone tissue reaches the neck of the tooth.

2. Localization of the abraded surface:

• horizontal - the tooth is erased from the cutting or occlusal surface;
• vertical - tissue loss occurs from the lateral parts: palatine, cervical;
• mixed - the tooth is abraded simultaneously from all sides.

3. The prevalence of the pathological process:

• localized - one or more teeth are worn out, its cause is the removal, incorrect installation of prosthetic structures;
• generalized - uniform tissue loss on all chewing and cutting units.

This is what broken teeth look like.

Important! Pathological abrasion is characteristic of both permanent and milk teeth.

Diagnostics

The initial diagnosis consists in taking an anamnesis and visual examination:

1. The reasons for the development of the disease are clarified, whether there is a hereditary factor, the patient's lifestyle and habits.
2. The state of the contact surfaces, the degree of their abrasion is assessed.
3. The oral mucosa is examined and soft tissues are palpated. Excluded possible changes in the work of the temporomandibular joint.

Important! To assess the degree of abrasion, imprints of the dentition are made using wax or silicone material - an occlusiogram. Normally, traces will be visible on the cast at the point of contact of the jaws.

Additionally, the following examination methods are used:

Treatment of pathological abrasion

If tooth wear is detected, treatment is carried out by one of the following methods, depending on the degree of development of the disease:

1. Conservative. A set of measures is being taken to eliminate causative factor, recovery mineral metabolism and . Remineralizing therapy, intake of vitamin-mineral complexes, physiotherapy procedures, pastes that help reduce hypersensitivity are prescribed.
2. Composite restoration. The sharp edges of the crowns are polished, and the lost tissues on the cutting edges and occlusal surfaces are restored with light-curing materials.
3. in an orthodontic way. The dentition is restored with the help of stump tabs, crowns, bridges and prostheses.

Important! There is no single opinion when to start treatment of pathological abrasion of teeth and how exactly to carry it out. The general clinical picture, causes and habits of the patient play an important role.

If increased tooth wear is accompanied by bruxism, a protective mouthguard is made. It is worn at bedtime. AT severe cases it may be necessary to pre-elevate the occlusion with dentogingival systems.

When identifying problems with the digestive or endocrine system, it is first necessary to treat diseases that have led to tooth abrasion.

An important role in therapy is played by the patient's trust in the doctor and his willingness to fulfill the requirements of a specialist. If the patient cannot, due to certain circumstances, follow the chosen method, it is adjusted within reasonable limits, taking into account personal preferences.

Abrasion of the tissues of the teeth cannot be reversed. All medical measures aimed at slowing down the process and restoring the anatomical shape jaw row. To prevent the disease, it is necessary to timely correct bite defects, bruxism, replace lost chewing units, use protective measures while working in production.

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 wears off - this 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 wear occurs in various forms, and the degree of damage to each may differ. However, if the dentin is affected and the nerve dies, pathological process 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 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 symptoms of the disease:

• 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 on 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 performed using various structures. 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, a few restore 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 pathological erasure teeth of stages 3 and 4 necessarily begin 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. In addition to the preventive examination, it is 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.