Are there underlying psychological factors for tooth wear?

This summary is based on the article published in Special Care in Dentistry: The psychology of tooth wear (January/February 2013)

Context

Tooth wear, also referred to as tooth surface loss (TSL) or non-carious TSL, has been defined as the “pathological loss of tooth tissue by a disease process other than dental caries”. The etiological factors of tooth wear include attrition, erosion and/or abrasion.

Purpose of the Study

• Review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders.
• Review the comorbidity of these conditions and the relevance of other medical conditions and lifestyle factors, such as gastroesophageal reflux disorder, smoking and diet, in the expression of tooth wear.

Mental Health Disorders and Tooth Wear

Depression: There is an evident comorbidity between depression, GERD, alcohol abuse and smoking, with tooth wear being one of the main dental manifestations of such disorders.

Eating Disorders: Tooth wear is particularly evident on the palatal surfaces of anterior and posterior teeth and is caused by the purging behavior of gastric acidic contents and the elevated consumption of acidic carbonated drinks to boost energy or decrease the reflex hunger stimulus.

Alcohol Use Disorders: The tooth wear risk of alcohol use disorders arises, not only from the acidic erosive potential of alcohol, but also from the high comorbidity between alcohol, depression, GERD and smoking, as previously discussed.

Drug Use: Users who sorted the drug have a significantly higher prevalence of tooth wear in their anterior maxillary teeth in comparison with users who injected, smoked, or ingested the drug. Users reported xerostomia, clenching or grinding after taking the drug. The high consumption of carbonated drinks and alcohol (to combat dehydration) and bulimic episodes associated with drug use further compound the present tooth wear through the introduction of an erosive element.

Key Message

• A holistic, multidisciplinary, healthcare approach is required in management of tooth wear patients with underlying mental health disorders.
• Dentists can have an important role in identifying these mental disorders through the observed tooth wear. They can also play a key role in monitoring patients’ response and compliance to medical treatment through the monitoring of tooth wear progression and expression.

References

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• Chadwick RG , Mitchell HL . Conduct of an algorithm in quantifying simulated palatal surface tooth erosion . J Oral Rehabil 2001 ; 28 : 450 – 6.
• Hellstrom I . Oral complications in Anorexia nervosa . Scand J Dent Res 1977 ; 85 : 71 – 86.
• Hurst PS , Lacey JH , Crisp AH . Teeth, vomiting and diet—Study of dental characteristics of 17 anorexia nervosa patients . Postgrad Med J. 1977 ; 53 : 298 – 305.
• Moazzez R , Smith BG , Bartlett DW . Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion . J Dent 2000 ; 28 : 395 – 7.
• Al-Dlaigan YH , Shaw L , Smith A . Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds. Br Dent J 2001 ; 190 : 145 – 9.
• El Aidi H , Bronkhorst EM , Huysmans M, Truin GJ . Factors associated with the incidence of erosive wear in upper incisors and lower first molars: a multifactorial approach. J Dent 2011 ; 39 : 558 – 63.

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