Tooth wear

With an ageing UK population retaining teeth into later years, patients with tooth wear, often severe, may be regularly encountered in general practice. Patients can present from all areas of the age spectrum. Many of these patients can be effectively managed in the primary care setting with routine risk assessments and screening, and further progression can be prevented. Although the evidence base alludes to a clear awareness of the condition among general dentists (which is hardly surprising given that tooth wear is third most common form of dental condition after dental caries and periodontal disease) undertaking routine risk assessment and the use of clinical index for tooth wear charting, remains inconsistent.¹ This is likely to contrast with routine periodontal (index-based) screening.

The driving factors behind decision-making in clinical practice are often diverse. However, the fear of litigation or regulatory challenges, the impact of the healthcare system under which care is provided/funded, and the standard of undergraduate training are likely to be influential. There is limited information about the perceptions of teaching of tooth wear at the undergraduate level. Ambiguity remains with the diagnosis of this condition, such as with the lack of agreement on the use of a given clinical index for routine screening. The restorative management of tooth wear may also be complex, requiring a good working knowledge of clinical occlusion, dental aesthetics, the available dental materials, and their application. While rehabilitation of the severely worn dentition may sometimes be beyond the scope of practice for a general dental practitioner, forming a rudimentary diagnosis and providing preventive care should be a reasonable expectation.