 Hello everyone welcome back to another session in dentistry and more. Today we have a simple topic wasting diseases of teeth. Wasting diseases they are nothing but loss of tooth substances in amyl dentine and cement up due to various reasons. So we have abrasion, attrition, erosion and abstraction which is having different cause and different appearance. Now let us learn the wasting diseases of teeth. Wasting disease by definition which is given in Carranza textbook of periodontology it is defined as gradual loss of or any gradual loss of tooth substance which is characterized by formation of smooth polished surface without regard to the possible mechanism of this loss. So the tooth structure loss without a possible mechanism that is wasting diseases it is gradual loss of tooth substance which is characterized by the formation of smooth polished surface without regard to the possible mechanism of this loss. So that is a definition given in Carranza textbook of periodontology. So we have four types of wasting diseases they are abrasion, attrition, erosion and abstraction. Abrasion is nothing but the loss of tooth substances by a foreign object which is acting in a sliding or rubbing action such as tooth brush. So this is mechanical action. We can say abrasion is most commonly on the left side of arch that is left side of the patient for a right-handed person because the right-handed person holds the brush in right hand and applies more pressure on the left side rather than the right side. So the most common reason for abrasion is tooth brushing that is a v-shaped notches we can see on the premolars and molars canine region. So we can say a combination of a hard tooth brush an abrasive toothpaste and an intense horizontal brushing technique is believed to cause a well-defined v-shaped notches in the cervical regions of panoramic facial tooth surfaces where the dentine and cementum are less wear resistant than the coronal enamel. So it is mostly on the cervical regions because the cervical region is basically covered by the cementum and dentine. In the coronal side it is enamel and dentine. So cementum has less wear resistance compared to the enamel. So it is a combination when we have a horizontal technique. So that is why always dentists prescribe a parallel technique parallel to the long axis of teeth which removes the internal debris also. Most commonly people prefer horizontal technique. So along with this detrimental horizontal technique abrasive toothpaste and a hard tooth brush will result in a v-shaped notch in the cervical regions of the facial tooth surfaces. So where it is more pronounced in the tooth region or the cervical region where the cementum and dentine are less wear resistant than the coronal enamel. So abrasion there are many habits which causing abrasion such as the misuse of dental floors and toothpick and pipe smoking and also thread biting. So abrasion can also seen in people like people who holds hair grips between the teeth. So in like professions and seam stresses and hairdressers so these people also may have tooth abrasion. So that is a mechanical force and basically it is due to the tooth brush and also other reasons which I mentioned like so that is about abrasion which is a mechanical reason mainly due to tooth brush and other reasons like dental floors, toothpick, pipe smoking, thread biting, holding hair grips are also result in enamel dentine or cementum loss which is basically a v-shaped notch appearance. Now let's move on to attrition which is a physiological cause it is resulting from tooth to tooth contact that is two body wear produce well defined wear facets on the functional surface of the teeth. So always these functional surface of teeth in one jaw which match corresponding lesion on the teeth in the other jaw that is why it is known as two body wear. So if it is present on the upper teeth opposite teeth also will have the same or almost same tooth loss which is known as attrition. Okay so it is two body wear because it is a tooth to tooth contact so it is two body wear and it is commonly seen in people with stresses and loss of the occlusion space usually we have a two mm gap when our upper and lower jaw are at rest. Some people may not have this closed space and the small space people with people who lacks this particular space may have a habit of continuously grinding their teeth and also when stress factors are there people used to grind their teeth and also night grinding also there. So when people grind the teeth unintentionally other than the reasons for mastication the tooth will be the two structures will be lost on the functional surfaces. So these people will have wear facets a poly surface on the occlusion surface basically on the maybe on the premolars and molars. So upper and lower teeth also both the teeth are having tooth loss at the same time. So para functional habits such as Braxism and clenching are also believed to be an important factor which causing this accelerated attrition. So attrition is a physiological tooth wear two body wear and resulting in a wear facets on functional surfaces that is like a polished surface on the occlusion surface. Abrasion is a mechanical one some foreign object should be there like toothbrush hair flows or toothpick whereas the erosion erosion is completely different and before that attrition can also due to reasons such as there is a tooth natural tooth which has a an antagonist tooth an opposite tooth which is made up of porcelain like we are having a artificial tooth which is made up of porcelain or other any metal artificial tooth which can result a tooth wear on the natural tooth okay and people who are having a coarse diet and also some developmental defect also lead to attrition along with our normal grinding that is tooth to tooth chewing. Now let us move on to erosion so erosion is nothing but a loss of tooth substance due to acid the acid could be or the reason could be intrinsic or extrinsic. So erosion is basically defined as a reversible loss of dental heart issue by chemical process that does not involve the bacteria okay so in dental caries we know there is involvement of bacteria which produces acids which in turn causes re-menalization or the softening of enamel and leads to cavitation whereas in erosion the same process acids are there acid production is there or acid presence is there but there is no involvement of bacteria okay so dissolution may occur on exposure to acid that can be introduced into the oral cavity. So erosion most commonly present as a broad shallow saucer shaped defects involving enamel and dentine and there will not be any sharp line angles and the margins of the defects are not well defined. The surface appears very smooth and polished occurs on the facial or lingual surfaces but usually on the lingual surface of maxillary anteris because persons who was having this GRD gastroesophageal reflexes the stomach acids frequently comes and get contact with the palatal surface of maxillary anteris and we may also have exogenous acids such as lemon juices or any other aerated drinks which we commonly have like Pepsi Coke or such aerated drinks lemon juices other citric juices which under erosion. So endogenous causes are also there exogenous endogenous means the causes found within like our gastric acids okay frequent people with frequent vomiting also can have this problem. Exogenous sources are sources which is coming from outside such as the juices or the food which contains more acids. So endogenous causes which cause erosion on the lingual incisal and occlusive surface whereas exogenous causes could affect on any exposed surface of the teeth. Now we have the last one abstraction okay abstraction is a pathological loss of tooth substance due to biomechanical loading forces that results in flexure and ultimate fatigue on enamel and dendrine at location away from loading okay. So usually we have a tooth this is a tooth suppose and occlusal forces are coming like this but if forces are at a different angle okay different angle but our tooth's long axis is like this which is creating an angle any angle it and it affects mainly on the gingival third of clinical crown. So we thought before we had a notion that the gingival third of crown is mostly affected by aberration but abstraction also seen at the gingival third of clinical crown okay. And this abstraction appear as a shaped defect on the facial aspect with sharp margins and internal line angles and initial stages the enamel surface is rough and shows striations or grooves later stages the defects progresses deeper in dendrine on the when it is going on an accelerated face okay. So how do we manage this? So management is aberration on aberration we need to think of tooth brush okay because this is the reason which causes tooth loss. So we need to think of soft tooth brush okay. So we can go for filling composite or GAC filling also we can think of fluoride varnish. Whereas in erosion we need to think of changing diet okay diet is the main course and we need to solve the problem which is causing in endogenous cases if it is GERT or any such diseases patient suffering from we need to think of managing that problem also. Whereas in abstraction we need to think of occlusion adjustment so occlusion adjustment should be there occlusion adjustment in case of abstraction okay. So attrition attrition we can think of it is a minimal where happens always in an attrition. So we can think of desensitizing agents such as topical fluoride varnishes or sensitive toothpaste. We have many brands in the market sensor dine sensor dent which is basically having a product potassium nitrate or strontium nitrate which is the component which seals the tooth dentine. So we can think of those tooth paces or we can go for composite restoration or any orthodontic treatment or crown lengthening procedures or protective spleens all we can apply okay. So that is all about wasting diseases of teeth. So we have four categories abrasion which is mechanical and tooth and other reasons could be tooth flows tooth picks and hair pins holding of hair pin. Attrition is just physiological two body wear tooth to tooth con and it is a physiological nature erosion is chemical it could be endogenous or exogenous. Abfraction is due to the tensile stress of occlusion loading and this is like a v-shaped notch where facets there will be broad concavity and enamel grazing and microfacer and almost like a v-shaped notch with line ankles and management is soft toothbrush this is like attrition we need to use desensitizing toothpaste and also other orthodontic and crown lengthening all other procedures erosion we can first we need to manage the course if it is endogenous and modifying the diet and the same procedure we can go for such as restorations and other procedures abstraction we need to do the occlusion correction. So I will come up with a new topic in dentistry and more thank you.