DENTAL EROSION OVERLOOKED AS A CAUSE OF TOOTH WEAR ...

PRESS RELEASE: MONDAY JANUARY 7, 2013
Author: Dr Andrea Shepperson
DENTAL EROSION OVERLOOKED AS A CONTRIBUTING
FACTOR IN THE WORN DENTITION
The increasing prevalence of erosive tooth wear 1 ,2,3,4 across all generations is often
overlooked by general practitioners, according to a leading New Zealand dentist Dr
Andrea Shepperson.
“Erosive tooth wear is a multifactorial condition of increasing concern to the clinician.
The consequence is a worn dentition with an aetiology often labelled “bruxism” when
the primary aetiology for wear may often be an acid source”, says Dr Shepperson.
While a certain amount of tooth wear is the consequence of attrition, it has been
estimated to be approximately 11 microns of enamel per year 5 . Wear beyond these
levels is not commensurate with age and usually stems from other causes. A careful
history, including an assessment of intrinsic and extrinsic sources of acid, needs to
be part of a thorough clinical assessment in cases of tooth wear.
Erosive wear can lead to significant loss of vertical height in the dentition as cusp tips
are worn and a changing anterior tooth relationship develops. Posterior cusp loss
impacts on the envelope of function anteriorly, often creating associated anterior
wear. This creates restorative challenges for dentists who are uncomfortable
increasing vertical dimension.
Occlusal concepts have long been considered the domain of the prosthodontist and
an understanding of occlusion has carried an air of mystique for the general dentist.
Shepperson believes that all general practitioners need to recognise when the OVD
needs to change to improve force management strategies and enhance the life of
natural teeth and restorations.
Shepperson frequently sees treatment planning that overlooks loss of occlusal
vertical dimension (OVD) and it’s impact on the overall dentition.
“I see implants placed and restored posteriorly to a worn and altered occlusal plane
while the patient continues to have erosive and associated wear across the
remaining arch. The patient presents with concerns about appearance, usually
related to loss of tooth display or chipping and fracture of anterior teeth. They are
often distressed to find that the OVD needs to change, and this requires dismantling
implant supported crowns which are providing inadequate posterior support.”
Developing treatment strategies to manage OVD changes requires knowledge,
experience and systems built around good clinical evidence.
“I work with general practitioners who understand the need to have a healthy
functioning occlusion, and seek the steps to create it clinically, before embarking on
occlusal reconstruction. Helping dentists to visualise an end point for the dentition
before embarking on major treatments such as implant dentistry or crown and

idgework involves recognising occlusal risk factors, as well as one’s own clinical
limitations.“
Shepperson has developed a special interest in restoring dentitions affected by
erosive wear. There is an opportunity to be involved in rewarding care at a
comprehensive level, often resulting in significant improvements in the quality of life
for many patients. Initial diagnosis, implementing preventive strategies with a
hygiene team, conservative minimally invasive restorative options, and
reconstruction of the smile and restoration of the entire arch are all aspects of her
work. She works closely with gastro-enterologists in patients suspected of having
gastric reflux disease. “We use ambulatory pH monitoring to determine the proximal
extent of acid reflux. The patient is often surprised and grateful for the role we play
in contributing to their oral health”, says Shepperson.
Shepperson will be in London discussing Dental Erosion: Restorative
Management of the Worn Dentition in a full day lecture on Friday March 22 at
Chandos House, London.
Further information is available at www.sheppersoneducation.com/London.html
MEDIA ENQUIRIES
Dr Shepperson is available for comment by request.
Email: ashepperson@gmail.com
Web: www.sheppersoneducation.com
Tel: +64 21 737 030
REFERENCES
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adolescents of mixed ethnicity.
Int J Paediatr Dent 2003;13:295–303
2. Lussi A, Schaffner M: Progression of and risk factors for dental erosion and
wedge-shaped defects over a 6-year period.
Caries Res 2000;34:182–187
3. Xhonga FA, Wolcott RB, Sognnaes RF: Dental erosion. II. Clinical
measurements of dental erosion progress.
J Am Dent Assoc 1972;84:577–582
4. Lussi A, Schaffner M, Hotz P, Suter P: Dental erosion in a population of
Swiss adults.
Community Dent Oral Epidemiol 1991;19:286–290
5. Pintado MR, Anderson GC, DeLong R, Douglas WH. Variation In Tooth wear
in Young Adults Over a Two Year Period.
J Prosthet Dent 1997;77:313-320