Worn down by toothwear? aetiology, diagnosis and management revisited

It is accepted that a degree of toothwear occurs naturally with age. Excessive toothwear, however, can be exceedingly damaging; causing painful symptoms, poor aesthetics or problems with eating and speech. Anecdotal evidence suggests that patients are increasingly presenting with problems of toothwear both in primary and secondary care settings. This article describes the aetiology, diagnosis and treatment options for toothwear and aims to help clinicians manage patients with this condition.

Toothwear can be defined as ‘the loss of tooth substance by means other than caries or dental trauma’. Tooth surface loss (TSL) is an alternative term used which can confuse dentists and patients, and can understate the severity of the problem by implying that only the surface of the tooth is lost.1 The term toothwear is easy for patients to understand, which is very important, as successful management of the condition depends on the patient's understanding of the wear process and its aetiological factors. There are different types of toothwear which can occur in isolation but which more commonly occur in combination: