Dental erosion and bruxism. A tooth wear analysis from south east Queensland

Tooth-tissue loss from erosion and attrition from bruxism were associated findings in 104 patients with excessive toothwear from South East Queensland. Approximately one-third of these subjects had been given a diagnosis of bruxism prior to referral. After a structured interview and clinical examination, the prevailing diagnosis was tooth erosion associated with occupational or sports-related dehydration, and one-third of the subjects were provisionally classified as bruxers. Eight items of clinical history and examination, designed to differentiate bruxers from non-bruxers, were analysed retrospectively from their records. These clinical items, by which the diagnosis of bruxism might be made, segregated the subjects into three groups of equal size, 'bruxers, possible bruxers and non-bruxers,' by a notional score for bruxism. The presence of occlusal attrition or erosion on the sextants of the dentitions was determined by scanning electron microscopic criteria on epoxy resin dental casts. The incidence of attrition versus erosion was compared between the three groups. The hypothesis was that attrition would be found on more sextants of bruxers than non-bruxers. Erosion predominated in virtually all sextants in all three groups, to the virtual exclusion of attrition in the molar sextants. The exception was the mandibular anterior sextant, where more sextants in bruxers were affected by attrition. Thus extrinsic or intrinsic acid erosion was strongly associated with occlusal tooth wear found in bruxers. Conversely, tooth-wear patterns were unreliable indicators of a bruxing habit, for attrition alone was often found on acid-exposed teeth. Thus, even if a patient is suspected of having bruxism, dental erosion is more likely the cause of tooth-tissue loss than attrition, especially in the dehydrating environment of South East Queensland.