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What is Dental Attrition? Causes, Consequences and Treatments

Dental attrition is a frequently occurring yet often unnoticed condition characterized by the gradual wearing down of teeth. Unlike erosion, which results from the action of acids on tooth enamel, attrition is mainly caused by the mechanical forces of chewing and bruxism. 

Bruxism, i.e. teeth grinding, is a major cause of this particular type of wear and tear. Understanding the difference between attrition and erosion is key to accurate diagnosis and appropriate treatment. Dental attrition can affect anyone, but it is especially common in older adults, due to the natural wear and tear of dentition over time.

Causes of dental attrition

The reasons for dental attrition are varied and often interrelated. One of the main causes is bruxism, or teeth-grinding. This disorder is often characterised by nocturnal involuntary clenching or grinding of the teeth. It can be exacerbated by stress, anxiety, or some types of sleep disorders.

In addition to bruxism, normal chewing also contributes to tooth wear, albeit much more slowly. Hard or abrasive foods can speed up this process, as can a “bad bite” or incorrect alignment of the teeth. Other behaviors such as chewing on objects that are not food (pens, nails) can contribute to accumulated dental damage.

Dental attrition can be aggravated by external factors such as acid erosion. Acidic foods and drinks, such as citrus fruits and sodas, can soften the enamel, making teeth more vulnerable to mechanical wear. The effects of acid erosion and abrasion (caused by contact with foreign objects such as a hard toothbrush) can often be confused with attrition, but there are different mechanisms involved. Abfraction is something else again: the loss of tooth structure at the neck of the tooth, often caused by pressures within the oral cavity.

Dental attrition impact and risks

Tooth wear due to attrition can have significant consequences on oral health. As the enamel wears away, dentin, a softer, yellower substance, is exposed. This can lead to increased sensitivity to hot and cold temperatures and to sweet or acidic foods. In addition, enamel loss puts teeth at an increased risk of cavities because dentin is less resistant to acid attack. Teeth can also become shorter, which affects the aesthetics of the smile and can affect the bite.

Damage caused by attrition can also compromise the structural integrity of individual teeth, requiring complex dental treatments such as crowns or veneers to restore tooth shape and function. In severe cases, attrition can even lead to tooth fractures, which require more invasive procedures such as dental implants.

Dental attrition diagnosis and treatment

A thorough clinical examination is required to make an accurate diagnosis of dental attrition. The dentist will inspect the occlusal surfaces (biting edges) of the teeth for signs of characteristic wear, such as flattening of the cusps or exposure of the dentin. Dental X-rays can also be used to assess the extent of tooth loss and to confirm that the damage is not another form of tooth wear such as erosion or abfraction.

Treatment for dental attrition depends on the severity of the wear and the underlying causes. For mild cases, adjustments to the bite or wearing an aligner at night to minimize the impact of bruxism may be sufficient. In more severe cases, dental restorations like crowns or veneers may be necessary to protect the teeth and restore their appearance and function.

Addressing the underlying causes of attrition is crucial to prevent it from worsening. This can involve making changes to a patient’s diet to reduce the intake of acidic foods and beverages, using soft toothbrushes, and employing less abrasive brushing techniques. Patients who grind their teeth may benefit from pursuing stress management techniques or behavioral therapies to reduce episodes of teeth grinding.

Prevention and recommendations

To prevent dental attrition, practise good oral hygiene and appropriate behaviors. Using a soft-bristled toothbrush and gentle brushing technique will minimize abrasion. You can also choose non-abrasive toothpastes for an even softer approach. Reducing the intake of acidic foods and beverages is crucial to protect tooth enamel from erosion.

Patients should also be alert to signs of bruxism, such as jaw pain or worn teeth, and consult their dentist for appropriate advice and treatment. Wearing a protective aligner at night can prevent excessive tooth wear in people who grind their teeth at night.

Dental attrition is a significant oral health problem that can have a real impact on your quality of life. By understanding the causes and consequences, as well as adopting adequate preventive measures, it is possible to preserve the health and functionality of the teeth in the long term. Regular consultation with a dentist is essential to monitor tooth wear and intervene quickly if necessary.

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