Minimum intervention dentistry and the management of tooth wear in general practice

The incidence of tooth wear, or non-carious tooth surface loss (NCTSL), is increasing and oral rehabilitation of patients with non-carious tooth loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the condition. The multifactorial nature of tooth wear and the variability in its clinical presentation provides treatment challenges for the clinician and successful management must be more than just restoration. Management must include an appropriate mix of preventive and restorative strategies and an understanding that long-term restorative success is affected by the patient's oral environment, and how diet, lifestyle and medical status can modify this environment. Ultimately, the success of any restorative intervention is very dependent on the stability of the oral environment and the condition of the remaining tooth structure. Minimum intervention dentistry (MID) philosophies are ideally suited to tooth wear cases and an overall MID strategy involving diagnosis, recognition and control of predisposing factors, stabilization of the oral environment, remineralization and restoration of the tooth structure, and ongoing maintenance can be implemented. When restorative treatment is required, contemporary materials and techniques are available that can provide cost-effective and conservative restorative alternatives for patients unable to undergo the complex indirect restorative techniques that are both costly and time consuming to implement. These minimally invasive approaches are not only an economically viable solution, but can provide aesthetic and functional rehabilitation and maintain tooth structure as a precursor to more complex restorative options when required.