Abstract
Given the number of perceived myths and fallacies in relation to tooth substance loss, this article seeks to address these using a wide variety of clinical cases as examples and by way of scientific references.
References
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McNamara's Fallacies in Dentistry. 2: Tooth Surface Loss Fallacies
From Volume 48, Issue 5, May 2021 | Pages 343-356
Article
In Part 1 some of the follies of using McNamara's fallacies were outlined. Fallacies are errors in reasoning, and not necessarily errors about truth or falsity. This part will highlight the ‘measurement and monitor’ approach to patients with tooth surface loss to illustrate some points made in Part 1 and it will expose some other unfortunate fallacies that have also affected UK dentistry.
One shibboleth is that tooth surface loss is always multifactorial. That is true sometimes – but not often – and certainly not always. For instance, one simple diagnostic clue is that if the length of the anterior maxillary teeth is reduced to be about the same, or less than their width, but the opposing lower incisors have a normal height to width ratio, then the main cause must have been chemical erosion.
The reasoning behind being able to make that important diagnosis confidently is that the appearance mismatch in the different heights of the teeth versus their widths must have been caused by a low pH acid eroding the upper teeth preferentially. That erosion is often due to hydrochloric acid with a pH of 1–2, coming up from the stomach, probably due to bulimia or gastro-oesophageal reflux disease (GORD). However, it could be due to multiple acid attacks coming in from the diet, and passing over the palatal and incisal aspects of the upper teeth, or sometimes a combination of both.
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