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Regressive alterations of teeth

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Attrition
Includes variety of alteration that are not necessarily related either etiologically or pathogenetically
ATTRITION
- Physiological wearing away of tooth as a result of tooth to tooth contact, as in mastication
- Phenomenon is physiologic rather than pathologic
  Clinical feature
 Men> female
–masticatory force
–chewing tobacco habits
–bruxism


 Attrition
•Polished facet  on cusp tip or ridges or slight flattening of incisal edges
•Gradual reduction in cusp height
•Flattening of occlusal plane
•Shortening of the length of the dental arch
•Pulp protection during attrition

ABRASION
•Pathologic wearing away of tooth substance  through some abnormal mechanical process
• Present in exposed root surfaces of teeth
•V- shaped / wedge-shaped, ditch
•Sharp angle formed between abraded region and rest of tooth
•Exposed dentin is highly polished

Cause of abrasion
•Abrasive dentifrices
•Habitual pipe smoking
•Occupation of the patient
–Carpenters
–Shoe makers
–Tailors
–Hair dressers

EROSION

•Irreversible loss of dental hard tissue by a chemical process that does not involve bacteria
•Dissolution of mineralized  tooth structure
•Causes of erosion

Erosion
Extrinsic
•Acidic beverages
•Citrus fruits
•Medications
•Environmental acids

Intrinsic
•Gastroesophageal reflux
•Vomiting
•Acidic beverages
Depends on
•Frequency
•Method of intake
•Medications
•Direct contact with the teeth
•Chewed or held in mouth prior to swallowing
    - vitamin C preparation 
•Occupational
•Acid vapours
    -Chronic hydrochloric, sulphuric, nitric acids
•Swimmers
•Occupational wine tasters

Intrinsic
Gastroesophageal reflux disease
   - Gastric acids pass involuntarily into the    esophagus and escape up into mouth
•Vomiting
•Medication
•Antidepressant medications
 Salivary hypofunction
•Saliva as modifying factor
•pH of saliva maintained by  bicarbonate
•Dependent on salivary flow rate
Acid enters the mouth
Saliva flow rate, pH, buffering capacity increases
Acid is neutralized
Treatment
•Patient education and counselling
•GERD →  refer to physician
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