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At Rice Dentistry we are following the very latest methods in assessing tooth wear. We assess both the cause and the speed with which tooth wear is occurring. We use these methods to help direct us to the least invasive approach to protect our patients’ teeth for their lifetime.
Evaluating the Old Standards
Unfortunately, current tooth wear standards are not adequate to help us evaluate this challenge and determine the best approach to treating tooth wear. That’s according to a new study performed by researchers from the Netherlands.Researchers proposed four characteristics of an ideal tooth wear standard. They said it should:
- Assess mechanical wear and chemical erosion
- Have well-defined criteria
- Be easy to use
- Be applicable for research and in clinical practice
It’s crucial to be able to assess both types of wear. Many patients experience one form or the other of tooth destruction, and some experience both, and if the standard can’t be applied for all types, it won’t work well for matching people to the best treatments.
Well-defined criteria help ensure consistency from dentist to dentist and instance to instance. Again, this helps match patients and their proper treatments.
A scale that is complicated to use can lead to mistakes, which can lead to overtreatment or undertreatment of tooth wear.
The final characteristic is important because some scales designed for research don’t help us with patient evaluations.
Researchers evaluated four common tooth wear standards (the Eccles index, the Lussi index, the tooth wear index (TWI), and the basic erosive wear examination–if you’re curious).
They found that none of these standards fit all the desired criteria.
Designing a New Standard
Finding out that none of the current standards was suitable for use led researchers to call for the invention of a new tooth wear standard.
They proposed that the new standard would be a modular design, with different language for mechanical wear and chemical erosion. But once the rating was chosen, it would be designated with a single number.
Here’s how it would work. A wear rating of two for the occlusal surface would describe wear with dentin exposure on less than 50% of the horizontal surface area or a loss of one third of the height of the crown. The same rating applied to other wear surfaces (i.e. the sides of the tooth) would indicate that dentin was exposed over 50% of the surface area.
It will take a little testing and evaluation to see if this new scale will actually work as intended.
Assessing Tooth Wear Is an Art and Science
As with most things in dentistry, assessing tooth wear is both an art and a science. It depends on a combination of training, insight, and experience. Perhaps a new tooth wear scale will help reduce the learning curve for new dentists, but there’s still no substitute for working with a well-trained and talented dentist with years of experience.
Of course, it’s likely that we will eventually assess tooth wear via the same types of digital scans that are currently used to take impressions for Invisalign and restorations. We are pioneering work of this type at the Kois Center in a partnership with 3M.