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Medically Compromised Patients Medicine Oral Health Research

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)


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.


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1 Comment

  1. Gary Henderson October 2, 2013

    And yet our dental insurance companies refuse to pay for appliances for these people if there is anything OTHER than tooth wear involved ….headaches, muscle pain or TMJ pain or noises. Tooth surface loss is the primary reason to use an appliance, no matter what co-morbid conditions accompany the bruxism. The CDA needs to have a stronger voice in dealing with insurance companies who deny benefits to those policy holders who just happen to also suffer from pain, headaches, depression, etc.


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