Case of the Week

July 10, 2022

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There are 3 primary types of tooth wear:

1. Attrition - tooth on tooth wear
2. Abrasion - external surface to tooth wear (think food, toothbrush, etc.)
3. Erosion - acid dissolution of tooth structure

Attrition and abrasion tend to have a sharp or flat appearance. They lead to sharp corners and chipping.

Erosion, however, dissolves the teeth similar to the way flowing water wears down rocks on a riverbed. It leaves them with a smooth appearance.

Acid gets to our teeth one of two ways:

• Acid coming in (drink, food, etc.)
• Acid coming out (acid reflux, GERD, respiratory acidosis)

This patient presents with a combination of all 3 types of tooth wear.

I have highlighted below where the wear has taken the highest toll. You'll note that several of the back teeth have porcelain crowns on them. Porcelain is resistant to acid erosion.

You'll also note that the soft yellow dentin core of his teeth is exposed. Studies show dentin will wear at 7-10X the speed of enamel. Things will only accelerate rapidly from here.

Multiple root canals, tooth sensitivity and tooth loss are the likely outcome with this left untreated. However, if we intervene with porcelain restorations custom designed using a 3D blueprint, this patient can expect many decades of stability while enjoying an incredibly handsome and healthy smile.

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