Diagnosis and management of the worn dentition: risk management and pre-restorative strategies for the oral and dental environment.

The incidence of tooth wear or non-carious tooth surface loss (NCTSL) is increasing and oral rehabilitation of patients with tooth tissue loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the disease. The multifactorial nature of the disease and the variability in its clinical presentation provides treatment challenges for the clinician. Management of tooth wear must be more than just restoration. Risk assessment, compliance and a commitment from both professional and patient underpin overall success of the treatment. Understanding that long term success is affected by the patient's oral environment and how diet, lifestyle and medical factors modify this environment. Improvements in the quantity and quality of saliva and remineralization strategies to enhance the remaining tooth structure are essential pre-restorative requirements. Successful management requires recognition of the problem, stabilization of the oral environment, remineralization of the tooth structure and when appropriate restoration.