Chronic Dental Conditions in the Elderly
Conditions that develop over a long period, particularly in older individuals, include attrition, abrasion, and erosion.
Attrition
Attrition refers to the wearing away of tooth substance due to mastication.
Causes:
- Coarse, gritty diet
- Nervous habits (e.g., grinding teeth during anxiety)
- Bruxism (grinding teeth at night)
- Chewing on pipes
Sites Affected:
- Anterior teeth: Incisal edges
- Posterior teeth: Occlusal surfaces
Clinical Features:
- Affected surfaces appear smooth and polished.
- In advanced cases, incisal edges and cusps wear away, appearing peg-like, while the occlusal surface becomes flat or even hollowed.
- Despite severe attrition, pulp exposure is rare due to compensatory dentine formation.
- Attrition is incompatible with caries and periodontal disease since these conditions lead to tooth destruction and mobility, preventing attrition from occurring.
- Attrition may have a protective role against caries by eliminating stagnation areas on occlusal surfaces.
Abrasion
Abrasion is the pathological wearing away of teeth by foreign substances.
Causes:
- Chewing tobacco
- Vigorous tooth brushing, especially with abrasive toothpaste
- Professions involving repetitive biting habits (e.g., cutting thread)
- Hard tooth brushing with a horizontal sweeping action (most common cause)
Sites Affected:
- Cervical region of teeth (near the cementoenamel junction)—most susceptible to abrasion
- Corner teeth—most severely affected
Clinical Features:
- Significant gingival recession is observed, but no gingivitis occurs due to effective plaque removal.
- Progressive exposure of cementum and dentine, leading to grooved defects.
Erosion
Erosion refers to the progressive dissolution of tooth structure, typically caused by acids, though some cases have unknown etiologies.
Causes:
- Occupational exposure (e.g., battery or acid factory workers exposed to acid fumes)
- Dietary factors:
- Habitual sucking of citrus fruits for prolonged durations
- Excessive consumption of carbonated soft drinks (high in phosphoric acid), leading to developmental caries
- Gastroesophageal conditions:
- Chronic regurgitation of acidic gastric juice, as seen in acid peptic disease (APD), gastroesophageal reflux disease (GERD), and early pregnancy, predominantly affecting the palatal surface
- Erosion of unknown origin: Manifests as shallow, highly polished lesions on the labial surface
Treatment:
- Identification and elimination of the cause (occupational, dietary, medical factors)
- Application of protective coatings
- Use of fluoridated toothpaste
- Iontophoresis with sodium fluoride (NaF) for enamel reinforcement
