2010 RWISO Journal - Roth Williams International Society of ...

tion might have enabled us to circumvent pathologic tooth
wear while the patient was undergoing treatment?
In canine guidance, the horizontal forces are minimized
by limiting the contact of the supporting cusps with their opposing
fossae at or near their intercuspal position. All other
lateral contacts are prevented by the steeper inclination of
the canines. This causes the chewing movement to be more
vertical in the frontal view. Case 5 exemplifies the preservation
of tooth material in the presence of functional occlusion.
Upon lateral excursive movements, the canine guidance
provided sufficient clearance in the posterior teeth.
Many of our orthodontic patients already have worn
canines and incisors. Occlusal interferences, premature contacts,
and habitual bruxism and/or clenching all may act as
stressors. Tooth contact during swallowing occurs 2,400
times a day, according to Straub23 and Kydd. 24 These repetitive
static and cyclic occlusal loads could also cause wear
on the anterior, as well as the posterior, teeth. Although it is
difficult to quantify the amount of tooth wear precisely, especially
in cross-sectional studies, orthodontists can appraise
attrition of the incisal edges and canine tip most easily from
intraoral photographs. Why should orthodontists be aware
of tooth wear? What happens if the dentist ignores if they
ignore the problem? These are important questions, because
any patient who is not informed of tooth surface loss is put
at risk of having no choice in treating what can become a
severe condition. ■
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