Study Suggests a Standard System for Tooth Wear Evaluation is Needed

Defined as the progressive loss of a tooth’s surface due to factors other than those causing decay or dental trauma, tooth wear is becoming an increasingly prominent oral health problem. There is no one cause to tooth wear, and over several decades there have been several evaluation systems created and used by dentists to assess the wear on a patient’s teeth. However, none of these evaluation systems is universally accepted throughout the field of dentistry. Researchers are now recommending that dental practitioners develop and accept a standardized tooth wear evaluation system in order to more effectively address this growing dental problem.

In a study published by BMC Oral Health, researchers evaluated the four most commonly used tooth wear evaluation systems: the Eccles Index, the Tooth Wear Index, and Lussi Index, and the Basic Erosive Wear Examination. Each of the four systems share similar characteristics, but there are still notable differences between them all, and none of them complement each other. Also, none of these four systems was found to show all the characteristics that a hypothetical, broadly applicable tooth wear evaluation system would require.

All four of the systems included in the study were designed to evaluate tooth wear chairside, although three of the systems could theoretically also include data from photographs. The authors of two of the systems also stated that the use of dental casts for evaluating tooth wear was a possible option.

According to this study, all four systems were intended to diagnose erosive tooth wear—but a proper diagnosis cannot be made through simply grading the amount of tooth surface loss. The study authors suggested that recognition of the clinical signs of tooth wear, obtaining a proper oral history, and even saliva tests are all required for a complete, accurate tooth wear diagnosis. Of the four systems studied, none is suitable as a universally accepted evaluation model in its current form.

The study authors proposed the development of a modular evaluation system that includes all these characteristics, instead of one of the four systems included in the study, would be a more realistic, workable solution to diagnosing tooth wear and screening patients appropriately. They suggested that a possible evaluation system could be comprised of multiple modules that would be used to grade all subtypes of tooth wear. The new system could also be used for all types of assessments and all tooth surfaces. Dentists would be able to choose between partial or full assessments as necessary depending on the state of the patient’s teeth.

While more research is needed to explore and develop a new, universally accepted modular evaluation system, the researchers stressed that the dental community as a whole must accept responsibility for reaching an agreement on which evaluation system to use.