Complications in managing tooth wear; exploring a potential pitfall of using the dahl approach – a case study

Tooth wear (tooth surface loss) is often defined as loss of the dental tissues by any cause other than trauma or caries. It is a common condition in the dentate population, with the 2009 Adult Dental Health Survey recording 77% of British adults presenting with some form of wear to their anterior dentition, 15% of adults showing moderate and 2% showing severe wear.¹ Severe wear is significantly associated with increasing age² and, when considering the data from the Adult Dental Health Survey showing increased tooth retention throughout life,¹ the incidence of tooth wear is set to increase overall. Such information highlights the importance for general dental practitioners in assessing, diagnosing and managing cases of tooth wear.

The aetiology of tooth wear for each individual wear case should be identified. These cases usually show elements of erosion, attrition, abfraction or abrasion, but it is important to note that these often do not occur in isolation and each case is usually multifactorial. Elements can then be addressed through diet analysis, oral hygiene instruction, fluoride therapies and other preventive aids. Age is an important factor when assessing risk; the level of wear present in an 82-year-old could be deemed acceptable as it has occurred slowly over many years, but the same amount in an 18-year-old could be alarming, requiring greater intervention. A number of diagnostic or grading criteria exist to assess wear, such as the Smith and Knight Wear Index³ (Table 1) or the Basic Erosive Wear Examination⁴ (Table 2). The use of such an index may help guide users as to the severity of wear present and thus the level of intervention required.