30/10/2025
🦷 Differential Diagnosis of Severe Tooth Wear: Erosion, Abrasion, and Attrition
Severe tooth wear, as seen in the clinical image, can result from multiple etiologies that must be carefully differentiated to ensure proper diagnosis and management. The three main causes—erosion, abrasion, and attrition—may overlap, but each presents distinct clinical and etiological characteristics.
🔹 Erosion
This is the chemical loss of tooth structure caused by acids not involving bacterial activity. It may be extrinsic, resulting from frequent consumption of soft drinks, citrus fruits, or vinegar, or intrinsic, associated with gastroesophageal reflux, bulimia, or chronic vomiting. Erosive lesions appear smooth, shiny, and often affect the facial or lingual surfaces.
🔹 Abrasion
A mechanical process resulting from external physical forces, such as aggressive toothbrushing or the use of abrasive toothpaste. These lesions typically appear at the cervical region of the teeth and have a characteristic V-shaped or notched appearance.
🔹 Attrition
Caused by tooth-to-tooth contact, usually due to bruxism or malocclusion. It presents with flat, polished surfaces and loss of crown height, often accompanied by dentin exposure and increased sensitivity.
👉 Recognizing the origin of the wear—whether chemical, mechanical, or functional—is essential for designing a comprehensive treatment plan. Management may include habit modification, occlusal rehabilitation, night guards, and multidisciplinary collaboration with gastroenterologists, psychologists, or prosthodontists, depending on the underlying cause.
