Clinical Appearance of Attrition

Attrition of the occlusal surfaces is marked by a general flattening of the occlusal or palatal surfaces of the teeth that are engaged during lateral functional movements. The canines are often the most affected teeth. Attrition, unlike erosion, causes wear of amalgam and composite. The amalgam surfaces are often shiny and faceted in the occlusal contact areas. The patient may also have clenching or bruxist habits that may be associated with temporomandibular dysfunction.

With attrition, the worn occlusal and incisal surfaces are flat and come into contact in lateral mandibular movements. A diagnosis of attrition therefore requires that the involved teeth contact in the intercuspal position or in lateral excursion. Erosion tends to accentuate any wear facets (Fig. 5.1), giving the false impression that the patient engages in bruxist activity. Bruxism is often associated with masseteric hypertrophy, temporomandibular joint dysfunction, ridging on the side of the tongue (lingual crenulation) and cervical abfraction lesions on the teeth.

Fig. 5.1 Erosion is a common cause of noncarious tooth tissue loss, often acting in combination with abrasion and attrition

Fig. 5.1 Erosion is a common cause of noncarious tooth tissue loss, often acting in combination with abrasion and attrition

Tooth Erosion Cupping
Fig. 5.2 Rapid attrition removes the caries-prone fissure system and early caries

The incidence of occlusal caries in teeth undergoing rapid attrition is low because there is no caries-prone fissure system and early caries is abraded away (Fig. 5.2). In interproximal areas of teeth, caries can initiate and spread unhindered by the occlusal attrition.

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