Toothwear and the older patient

Toothwear is the gradual loss of tooth substance due to repetitive physical contacts or chemical dissolution. It can be caused by abrasion, attrition or erosion. The most common type of toothwear in older patients is physiological.

All dentate older patients will manifest some degree of toothwear. Whether this toothwear is of any clinical consequence and what the treatment need is are some of the issues which will be covered in this paper.

There are four types of toothwear:

A list of the causes of toothwear is shown in Table 1.

While it may appear excessive to cite aetiological factors such as pregnancy in an article about older people, it should be pointed out that what is seen in an older mouth is a culmination of a lifetime's experience.

A combination of signs and symptoms are used to diagnose toothwear.

Patients may present with tooth sensitivity, sharp edges to teeth (Figure 1), soft tissue trauma or pulpitis. Given that there is an increased amount of dentine and reduced nerve supply1 associated with ageing, pronounced sensitivity in an older patient would be indicative that the aetiology, usually erosive, is in an active phase. Aesthetic concerns can manifest as shortened teeth, altered tooth shape or reduced lower face height (Figure 2). The major function affected by toothwear is mastication, with patients presenting with reduced masticatory function or altered diet selection.