The role of erosion, abrasion and attrition in tooth wear.

There is increasing clinical awareness of erosion of enamel and dentine by dietary acids and the consequent increased susceptibility to physical wear. Enamel erosion is characterized by acid-mediated surface softening that, if unchecked, will progress to irreversible loss of surface tissue, potentially exposing the underlying dentine. In comparison, dentine erosion is less well understood as the composition and microstructure are more heterogeneous. Factors which affect the erosive potential of a solution include pH, titratable acidity, common ion concentrations, and frequency and method of exposure. Abrasion and attrition are sources of physical wear and are commonly associated with tooth brushing and tooth-to-tooth contact, respectively. A combination of erosion and abrasion or attrition exacerbates wear; however, further research is required to understand the role of fluoride in protecting mineralized tissues from such processes. Abrasive wear may be seen in a wide range of patients, whereas attritive loss is usually seen in individuals with bruxism. Wear processes are implicated in the development of dentine hypersensitivity. Saliva confers the major protective function against wear due to its role in pellicle formation, buffering, acid clearance, and hard tissue remineralization. This review focuses on the physiochemical factors impacting tooth wear.