Age-related tooth wear is a natural process associated with active use. oral cavity for crushing and chewing foods, including hard ones. Sometimes increased tooth wear is diagnosed in people under the age of 40, which indicates pathological changes in the dental tissues and the need for effective treatment.

In the article we will look at what affects the premature destruction of dental tissues, what symptoms accompany this process and how to get rid of the problem.

Tooth wear

With a normal bite, a person wears out faster outer side the lower teeth and the inner one on the upper teeth. The chewing surface of the molars regularly receives stress during food intake, which leads to the erasure of the natural cusps.

Normally, age-related erasure begins after 40 years, and the frequency of requests from men is several times higher than from women. If the problem is found in a teenager, young man under the age of 30, then we are talking about pathological abrasion.

Let's look at what causes it.

1. Use of medications. Some aggressive drugs (for example, based on of hydrochloric acid) lead to destruction of the top layer of enamel.
2. Heavy physical activity. Athletes and even loaders often experience pathological wear of teeth (photo above), which is associated with the tight closure of the jaws during heavy lifting.

Symptoms of pathology

Clinical picture characterized by accelerated abrasion of the top layer of the tooth (enamel) with a transition to soft fabrics(dentine).

When dentin is exposed, the tooth wears out much faster, resulting in chips, sharp edges, and gouges on the tooth.

Such defects lead to microtraumas of the mucous membrane, tongue and lips.

The initial stage is also characterized hypersensitivity enamels to temperature, chemical and mechanical factors. Sharp pain can be caused by heated or chilled food and drinks, too spicy, sour, sweet or salty dishes. Pain is also observed when touching the tooth during regular oral hygiene.

When dentin is exposed and the appearance of a replacement substance, sensitivity may temporarily decrease, while wear increases significantly.

Disease progression leads to rapid shortening of the length of the molar, which leads to visual changes in facial expressions and symmetry. Patients note drooping corners of the lips, problems and discomfort in temporomandibular joint. In some cases, hearing loss and pain in the tongue area may occur.

During this period, there is a change in the bite, which leads to inconvenience when biting and chewing food. In some cases, chewing disorders can even affect the digestive system.

The fissures are smoothed out during the erasing process. and irregularities, making the enamel surface smoother and more even. This allows you to partially get rid of early caries that lay at the bottom of such grooves.

Pathological abrasion of teeth upper jaw

In the case of increased wear of the incisors, the process sooner or later reaches the neck of the tooth, and the tooth cavity can be seen through defects in the dentin.

A deep bite is characterized by damage to the surface of the lower and upper incisors.

If the disease begins after tooth extraction, then neighboring teeth, as well as canines and incisors, are worn away.

When pathology is diagnosed in production workers chemical compounds, metal structures, as well as confectionery products, there is uniform damage to the enamel, an equally smooth surface of the teeth, and the absence of deep fissures. The surface does not have a normal glossy, but a matte shade without plaque or stone.

In some cases, exposed, smoothed dentin is noted. If the patient works in an acid production plant, the molars may be worn down to the neck. In this case, a person feels a rough tooth surface, pain, and discomfort while chewing.

On late stages The disease causes a change in the position of the teeth, their mobility and even loss. Resorption of hard tissues at dental roots and septa is also possible.

Diagnosis and treatment of the disease

Treatment of pathological tooth wear will depend on the type of pathology, initial reasons and stages of the disease.

Before starting therapy, the dentist conducts a thorough diagnosis and helps eliminate the problem that caused the increased wear. After this it is assigned rehabilitation treatment, which allows you to restore teeth and restore the aesthetics of the row.

Diagnosis involves collecting anamnesis, analyzing the patient’s subjective complaints, and determining the cause of abrasion. Dentist conducts visual inspection oral cavity and dentition, taking into account changes in bite and facial symmetry.

He also establishes the nature and degree of occlusion, notes visual symptoms, determines the hardness and resistance of tissues, and the degree of abrasion of enamel and dentin.

Dentists treat increased tooth wear

The condition of the root canals and pulp cavity must be assessed using electroodontodiagnostics, X-rays, and orthopantomography.

By using computer programs The dentist studies the model of the jaw, determines the shape, depth and degree of damage to the tooth, and the occlusal relationships of the upper and lower rows.

In the later stages, it is necessary to study the functioning of the jaw and masticatory muscles, for which X-rays, tomography of the TMJ, electromyography, etc. are used.

Treatment is usually carried out by dentists: therapist, orthopedist, orthodontist.

At the first stage, the causes of erasure are eliminated, which requires curing systemic and dental diseases, put a normal bite, change dentures or implants, give up bad habits, change diet or even place of work, restore extracted teeth in the form of crowns, etc.

At the same time, auxiliary medications are prescribed, food additives and vitamin-mineral complexes, which allow you to restore the balance of substances in the body, ensure the normal supply of calcium, mineral salts, fluorine and other microelements beneficial for teeth.

Next, hyperesthesia of the dentition is eliminated through remineralization. The patient continues to take vitamin and mineral complexes and attends physiotherapeutic procedures (electrophoresis). Applications based on fluoride-containing preparations are carried out.

Sharp edges, chips and enamel defects are ground to a smooth surface that is safe for soft tissues.

Mouth guard for bruxism

Defects and gaps in the dentition are corrected using prosthetics and implants.

To treat bruxism, customized night guards are prescribed to eliminate wear and tear on the enamel during night grinding.

The final stage is the restoration of the natural shape of the teeth (crowns, incisal edges, etc.) using filling composites, core inlays, veneers, artificial crowns, lumineers or artistic restoration.

To avoid long and expensive treatment, you need to pay timely attention to the condition of your teeth.

If you note the symptoms indicated in the article, notice a decrease in the length of the tooth or chips on the enamel surface, then make an appointment with the dentist to exclude increased tooth wear. Also, do not forget to take the microelements and vitamins necessary for dental health, purified water with normal level fluorine

Oral health is a very pressing issue for many. How beautiful and healthy a person’s teeth look can be used to judge his health, grooming and status. Ecology, stress, neglect of oral problems and non-systematic visits to the doctor contribute to the formation of various dental problems and diseases.

Pathological abrasion of teeth is a pressing problem. This is a normal physiological process of the body. In people with a correct bite, tooth enamel is scratched upper teeth begin with inside, and the lower ones, respectively, outside. The problem may arise when a person reaches a more mature age and develop into a pathological process.

According to statistical studies, 12% of the world's population is prone to pathological tooth wear (men are at greater risk - 63%). By the age of thirty, a certain layer of enamel is gradually worn away, and after fifty, the wear of the dentin layer is often recorded. If such problems begin to appear in more at a young age, we can talk about pathological nature this problem.

The main reasons for the appearance

Anatological abrasion of teeth is usually called the systematic abrasion of the enamel (in some cases, enamel and dentin) of all or several teeth. The level of neglect of this process can only be determined by a doctor using basic methods:

1. Examination of the jaw model using a cast.
2. Electrodiagnostics.
3. Electromyography.
4. Orthopantography.

Causes of dental pathology

Experts combine the main causes of this anomaly of tooth enamel into two groups, namely:

— Functional deficiency of hard dental tissues:

— Waste of human teeth due to problems associated with:

• loss of teeth (partial);
• bad habits, which very often become the cause of systematic injury to a person’s teeth;
• resulting hypertonicity of the human masticatory muscles (can be formed due to tense facial muscles);
• foodless chewing.

Classifications of increased tooth wear

The classification of this pathological disease is based on the forms and complexity of the disease.

There are main degrees of abrasion:

Taking into account the level of the erase plane, the following types are distinguished:

• Vertical, most often found in patients with malocclusion. Only the outer side of the tooth enamel is erased.
• Horizontal. As teeth wear down, the height of the crown decreases.
• Mixed. When this level of the disease is reached, erasure of the two previous types is characteristic.

Depending on the complexity of the process, they differ:

• local abrasion. In this case, one specific area is subject to erasure;
• generalized. In this case, the process completely affects all areas of a person’s teeth.

To summarize, we can talk about numerous variants of manifestation of this dental pathology, in which all the enamel can be completely erased or only some part of it, one side - or both at once.

Symptoms of the disease

The symptoms of this disease depend both on the degree of the disease and on its course.

It's broken from the start primary view teeth. If measures are not taken, the disease develops, causing the length of the tooth to become much shorter than before. The chewing function of a person is impaired. Patients note discomfort when eating hot, cold, sweet or sour foods, which indicates the onset of hyperesthesia.

Impaired chewing function is a sign of a disease called increased tooth wear. Tooth enamel is about five times stronger than dentin, therefore, until the enamel is completely erased, the symptoms are mild, but as soon as the enamel disappears, the symptoms will become more pronounced.

This pathology requires immediate appeal See a doctor while the symptoms indicate the initial stage of the disease. If left untreated, the consequences of the disease can be deformation of the joints, changes in the lower part of the face, and the appearance of severe pain.

Diagnosis of the disease

Diagnosis of pathological abrasion of tooth enamel includes an in-depth analysis of symptoms. Because of wide range Symptoms of abrasion can only be diagnosed by a dentist, taking into account all factors and the possible presence of other pathologies.

The examination scheme includes:

1. A complete examination and interview of the patient, studying the history of the disease to determine the forms and stage of the pathology.
2. Inspection of external signs.
3. Complete examination of the oral cavity and the condition of the patient’s masticatory muscles.
4. Study of the functions of the temporal and mandibular joints.

To study the picture of the disease, radiography, tomography, and electromyography can be used.

The initial examination of the patient's face includes studying the contours of the face, its symmetry and proportionality. Specialists analyze the degree of destruction of the mucous membrane, the level of tooth wear, and the condition of hard tissues to determine possible complications during treatment.

Examination of the masticatory muscles allows one to study their condition, possible asymmetry and hypertonicity. In this case, electromyography is often used. All this helps to minimize possible complications.

Examination of the temporal and mandibular joints allows us to determine different kinds pathologies that can occur with this type of disease.

Electroodontodiagnosis, or EDI. This type diagnosis is necessary, since in the pathology of tooth abrasion, the death of the pulp very often occurs, while the patient did not observe any signs of deviation. EDI is prescribed only for the second or third degrees of the disease, since in initial stage no symptoms appear.

Diagnostics allows us to identify the main causes of increased tooth abrasion. In addition to the oral cavity, doctors focus on the condition of the temporal and mandibular joints.

Forms of treatment

Treatment of this problem takes a lot of time, this is due to a huge variety of factors influencing the problem. In addition, it is important to determine the stage of development of the disease, this will help to select correct treatment and speed up the process.

To cure pathological abrasion of the first and second degrees, doctors first stabilize the already advanced process so that the disease does not develop.

At the initial stage, doctors install temporary dentures (to begin the restoration process and maintain chewing functions). After positive dynamics are observed, temporary prostheses are replaced with permanent ones.

Treatment of more advanced stages of the disease (third and fourth) begins with restoration of the bite. At this stage, experts strictly prohibit the installation of crowns, as this may cause the patient to develop an incorrect bite. As a result of their establishment, tooth tissue may be damaged.

Making prosthetics is an important issue. At the initial levels of development of this disease, prostheses are most often made from plastic, ceramics, and sometimes the choice falls on prostheses made from precious metals. In cases where the disease has progressed, prostheses made of ceramic or metal ceramics are often used.

When installing dentures, it is important to remember that the dentures must be made of the same materials, otherwise you may end up with a reverse (re-) correction of the bite.

If the cause of pathological tooth wear is heavy load or periodic contraction of the masticatory muscles, experts recommend installing dentures that are not susceptible to cracks (more durable): made of metal-plastic or metal. In this case, metal ceramics are strictly prohibited.

Main stages of treatment:

1. By installing temporary dentures, doctors correct the height of the bite.
2. The adaptation of teeth to the new position is analyzed.
3. After positive results temporary dentures are replaced with permanent ones.

Restoring the height of the bite at the first stage occurs through the installation of so-called plastic aligners.

The adaptation period is the patient's adaptation to other jaw positions. Most often, this period is characterized by severe discomfort. The patient must visit the dental office at least twice a week; this is necessary for clear monitoring and research of the results of wearing aligners by the dentist. More often average duration Wearing temporary aligners takes about two to three weeks. It is also necessary to take into account that adaptation begins from the moment the patient stops complaining about discomfort in the area of ​​the temples, mandibular joint, as well as in the area of ​​the masticatory muscles when eating food.

The third stage of treatment is the installation of permanent prostheses (final prosthetics). At this stage, special materials are selected to achieve the preservation of a correctly established bite. To achieve the best possible results, when making prostheses, doctors take into account the results obtained when wearing therapeutic mouth guards, which were installed temporarily.

The process of permanent prosthetics can take place either immediately or in stages. Aligners help determine the exact occlusal height for the patient. For the remaining areas, prostheses begin to be made after complete fixation of the first permanent prostheses.

Prevention of tooth wear

To protect yourself from the disease or from its reoccurrence, you must adhere to following rules and recommendations:

Treatment prognosis

The prognosis for treatment of this disease is generally positive. Of course, treatment takes a much shorter period of time if the patient turns to early stages diseases. In addition, younger patients are more likely to recover quickly. However, relapses of pathological tooth wear often occur, so dentists talk about the need to register patients suffering from this pathology.

Therapeutic dentistry. Textbook Evgeniy Vlasovich Borovsky

5.2.2. Abrasion of hard tooth tissues

Abrasion of tooth tissue occurs in every person, which is the result physiological function chewing. Physiological abrasion manifests itself primarily on the mounds of the chewing surface of small and large molars, as well as along the cutting edge and knobs of the fangs. In addition, the physiological surface of the teeth normally leads to the formation of a small area on the convex part of the crown at the point of contact (point contact) with the adjacent tooth.

Physiological tooth abrasion observed both in time and in permanent dentition. In the temporary dentition, when the incisors erupt, they have 3 teeth on the cutting edges, which are worn away by the age of 2–3 years.

Rice. 5.11. Abrasion of teeth.

Depending on age, the degree of physiological tooth wear increases. If up to 30 years of age, abrasion is limited to the enamel, then by the age of 40, dentin is also involved in the process, which, due to exposure, becomes pigmented in yellow. By the age of 50, the process of dentin wear intensifies, and its pigmentation takes on a brown color. By the age of 60, significant abrasion of the anterior teeth is observed, and by the age of 70 it often extends to the coronal cavity of the tooth, that is, sometimes even the contours of this cavity filled with newly formed tertiary dentin are visible on the worn surface.

Along with physiological pathological erasure, when there is an intense loss of hard tissue in one, in a group or in all teeth (Fig. 5.11).

Clinical picture. Pathological abrasion (abrasion) of hard dental tissues is quite common and is observed in 11.8% of people. Complete abrasion of the chewing cusps of large and small molars and partial abrasion of the cutting edges of the front teeth are more often observed in men (62.5%). In women, this process occurs much less frequently (22.7%). The reasons for increased abrasion may be the state of the bite, overload due to loss of teeth, improper design of dentures, household and professional harmful effects, as well as the formation of defective tissue structures.

With a straight bite, the chewing surface of the lateral teeth and the cutting edges of the front teeth are subject to wear.

As the cusps of the chewing surface wear away with age, the wear of the incisors progresses intensively. The length of the crowns of the incisors decreases and by the age of 35–40 it decreases by 1/3-1/2. In this case, instead of a cutting edge, significant areas are formed on the incisors, in the center of which dentin is visible. After dentin is exposed, its abrasion occurs more intensely than enamel, resulting in the formation of sharp edges of enamel, which often injure the mucous membrane of the cheek and lips. If treatment is not carried out, tissue abrasion progresses rapidly and the crowns of the teeth become significantly shorter. In such cases, there are signs of a decrease in the lower third of the face, which is manifested in the formation of folds at the corners of the mouth. In persons with a significant decrease in bite, changes in the temporomandibular joint may occur and, as a result, burning or pain in the oral mucosa, hearing loss and other symptoms characteristic of low bite syndrome may occur.

With further progression of the process, the abrasion of the incisors reaches up to the necks. IN in such cases through dentin The tooth cavity is visible, but its opening does not occur due to the deposition of replacement dentin.

With a deep bite, the labial surface of the lower incisors comes into contact with the palatal surface of the upper incisors and these surfaces are significantly erased.

The most pronounced tissue abrasion is observed in the absence of part of the teeth. In particular, in the absence of large molars, which normally determine the relationship of the dentition, intensive wear of the incisors and canines is observed, as they are overloaded. In addition, due to overload, tooth displacement and resorption may occur. bone tissue at the tips of the roots, interdental septa. Often, tooth wear is caused by improper design of removable and fixed dentures. When using a tooth under a clasp without an artificial crown, abrasion of the enamel and dentin at the neck often occurs. As a rule, patients complain of severe pain from mechanical and chemical stimuli.

As is known, the specific conditions of some industries cause the occurrence of occupational diseases. In a number of industries, teeth are damaged and frequently worn out. For workers involved in organic production and especially inorganic acids, upon examination, more or less uniform abrasion of all groups of teeth is revealed, there are no sharp edges. In some places exposed dense smooth dentin is visible. In persons with long experience Working in acid production plants wears teeth down to the neck. One of the first signs of abrasion of enamel under the influence of acid is the appearance of a feeling of soreness and roughness of the surface of the teeth. The change from a feeling of soreness to pain indicates the progression of the process. Chewing conditions may change. Upon examination, a loss of the natural color of the tooth enamel is revealed, which is especially visible when dried; a slight waviness of the enamel surface may be observed.

Individuals working in enterprises where there are excess mechanical particles in the air also experience increased tooth wear.

Often, increased tooth wear occurs in a number of endocrine disorders - dysfunction of the thyroid, parathyroid glands, pituitary gland, etc. The mechanism of erasure in this case is due to a decrease in the structural resistance of tissues. In particular, increased abrasion is observed with fluorosis, marble disease, Stainton-Candepont syndrome, primary underdevelopment of enamel and dentin.

For therapeutic dentistry, according to M.I. Groshikova, the most convenient clinical-anatomical classification is based on localization and degree of erasure.

Grade I- slight abrasion of the enamel of the cusps and cutting edges of the crowns of the teeth.

Degree II - abrasion of the enamel of the cusps of the fangs, small and large molars and the cutting edges of the incisors with exposure of the surface layers of dentin.

Grade III- abrasion of enamel and a significant part of dentin to the level of the coronal cavity of the tooth.

Abroad, the Bracco classification is most widespread. He distinguishes 4 degrees of abrasion: the first is characterized by abrasion of the enamel of the cutting edges and tubercles, the second - complete abrasion of the tubercles with exposure of dentin to 1/3 of the height of the crown, the third - a further decrease in the height of the crowns with the disappearance of the entire middle third of the crown, the fourth - the spread of the process to the level of the neck tooth

Beginners clinical manifestation The abrasion of teeth is caused by their increased sensitivity to temperature stimuli. As the process deepens, pain from chemical irritants, and then mechanical ones, may occur.

In most patients, despite pronounced degrees of abrasion, the sensitivity of the pulp remains within normal limits or is slightly reduced. Thus, in 58% of patients with tooth wear, the pulp response to electric current turned out to be normal, in 42% it was reduced to various levels (ranging from 7 to 100 μA or more). Most often, the decrease in electrical excitability of teeth ranged from 6 to 20 μA.

Pathological picture. Pathological changes depend on the degree of erasure. At initial manifestations When only slight abrasion occurs on the cusps and along the cutting edge, a more intense deposition of replacement dentin is noted according to the area of ​​abrasion. With more pronounced abrasion, along with significant deposition of replacement dentin, obstruction of the dentinal tubules is observed. Pronounced changes occur in the pulp: a decrease in the number of odontoblasts, their vacuolization, and reticular atrophy. Petrification is observed in the central layers of the pulp, especially in the root pulp.

At III degree After abrasion, pronounced sclerosis of dentin is observed, the tooth cavity in the coronal part is almost completely filled with replacement dentin, the pulp is atrophic. The number of odontoblasts is significantly reduced, and degenerative processes occur in them. The channels are difficult to navigate.

Treatment. The degree of abrasion of hard dental tissues largely determines the treatment. Thus, with I and II degrees of erasure, the main goal of treatment is to stabilize the process, prevent further progression erasing. For this purpose, inlays (preferably from alloys) can be made for antagonist teeth, mainly large molars. long time not susceptible to abrasion. It is possible to produce metal crowns(preferably made of alloys). If erasure is due to deletion significant amount teeth, then it is necessary to restore the dentition with a prosthesis (removable or non-removable according to indications).

Often, the abrasion of tooth tissue is accompanied by hyperesthesia, which requires appropriate treatment (see. Hyperesthesia of hard dental tissues).

Significant treatment difficulties arise with grade III abrasion, accompanied by a pronounced decrease in bite height. In such cases, the previous bite height is restored with fixed or removable dentures. Direct indications for this are complaints of pain in the area of ​​the temporomandibular joints, burning and pain in the tongue, which is a consequence of changes in the position of the articular head in the articular fossa.

Figure 5.12. Wedge-shaped tooth defect, a - diagram; b - appearance.

Treatment is usually orthopedic, sometimes long-term, with intermediate production of medical devices. The main goal is to create a position of the dentition that would ensure the physiological position of the articular head in the articular fossa. It is important that this jaw position be maintained in the future.