The paper attempts to describe the clinical stages in the management of a 21 year old male patient who presents with aesthetic concerns related to the pathological tooth surface loss affecting his anterior maxillary dentition. The management of tooth surface loss (TSL) demands a full understanding of its aetiology and presentation. This paper provides the introduction to the series and an overview of pathological, non-carious loss of tooth tissue . Emphasis is placed on the aetiological factors which are currently thought to be major causes of this problem. This directs the paper toward those agents that produce erosive tooth surface loss. This is appropriate given the increasing incidence and severity of this type of tooth wear.
Non carious loss of tooth tissue is a normal physiological process and occurs throughout life. If the rate of loss is likely to prejudice the survival of the teeth, or is a source of concern to the patient, then it may be considered 'pathological' . The dental management of patients with such loss of tooth tissue has provided difficulties for the dental profession for many years and it is generally agreed that the problem is increasing. This can only partly be explained by the fact that the population is retaining more natural teeth into old age. It is not only the middle-aged and elderly who exhibit pathological loss of tooth tissue, but also younger age groups (fig. 1). Robb reported that the prevalence of pathological loss of tooth tissue in patients less than 21 years of age was greater than in many older age groups . The Child Dental Health Survey (1994) confirmed this when 32% of 21-year-olds had evidence of erosion affecting the palatal surfaces of their permanent incisors. This cannot be explained as an age-related phenomenon. It may, however, be the result of changing lifestyles and social pressures which have led to the increased prominence of particular aetiological factors .
Dietary erosion may result from food or drinks containing a variety of acids, especially citric acid which may chelate as well as dissolve calcium ions. Citric and phosphoric acid are common constituents of soft drinks and fruit juices (Table 2). These beverages are now widely available, with a doubling of sales in the UK, since 1970 and a 7-fold increase since 1950 (Fig. 2). Adolescents and children account for 65% of sales with 42% of fruit drinks consumed by children between the ages of 14 and 21 years old . This consumption of soft drinks by this age group has been identified as the probable cause for the erosion recorded in the Child Dental Health Survey (1994).
It is generally accepted that the prevalence of TSL increases with age. However, the exact prevalence is unclear, primarily because of differing assessment criteria. Hugoson et al., for example, reported that 13-24% of surfaces showed evidence of occlusal wear. other studies have observed that between 25% and 50% of subjects had evidence of TSL. Some loss of tooth tissue is normal during a patients' lifetime ...