|Year : 2014 | Volume
| Issue : 4 | Page : 142-145
An easy classification for dental cervical abrasions
Madhuri Alankar Sawai
Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi, India
|Date of Web Publication||12-Sep-2014|
Dr. Madhuri Alankar Sawai
C-765, Ground Floor, Rear Portion, New Friends Colony, New Delhi - 110 065
Source of Support: None, Conflict of Interest: None
Introduction: Tooth wear - attrition, abrasion, or erosion - are modern day problems for dentistry. It usually leads to discomfort and sensitivity especially during eating, drinking, or tooth brushing. If left untreated for a long time, it may lead to loss of vitality of tooth. Various qualitative and quantitative methods have been used in the past to describe tooth wear. However, each method has certain shortfalls. There is no ideal index that is simple and clear in its scoring criteria. The Hypothesis: The classifications described in the literature are very descriptive and hence, it takes a long time to grade for a complete dentition. Some are based on the morphologic appearance and others on severity. A classification system has to facilitate standardized identification of a condition and help in diagnosis and treatment planning. The present manuscript is an attempt to emphasize the need to develop a classification system that is easy to score and describes the condition in details without utilizing much time. Evaluation of the Hypothesis: The hypothesis highlights some drawbacks of the classification systems available today and puts forth a new and easy to use classification system.
Keywords: Abrasion, cervical area, classification, indices, tooth wear
|How to cite this article:|
Sawai MA. An easy classification for dental cervical abrasions. Dent Hypotheses 2014;5:142-5
| Introduction|| |
Tooth wear leads to loss of tooth structure, producing varying symptoms to the patient. We, as dentists, diagnose, grade, and monitor tooth loss. This requires the use of indices to locate the area and grade the severity. Different indices have been given in the past to diagnose and grade the cervical abrasions: Eccles index for dental erosion of non-industrial origin  , Smith and Knight Tooth Wear Index  , and Erosion Index by Lussi.  Bardsley et al.  pioneered a new, simplified version of tooth wear index (TWI) and Khan et al.  reported cervical lesions of different morphological types. Similarly, a classification system based on morphology of the abrasion has also been given earlier by Micheal et al.  All these indices use qualitative or quantitative methods for clinical and laboratory use across the world. The quantitative index tends to rely on objective physical measurements, such as depth of groove, area of facet, or height of crown. In contrast, the qualitative methods, which rely on clinical descriptions, can be more subjective if proper training and calibration are not carried out but with correct safeguards, can be valuable epidemiological tools. 
| The Hypothesis|| |
The grading methods already given in the dental literature identify the severity and progression of tooth wear. Unfortunately, even though there are many indices, they do not properly reflect the morphological characterization. The comparison among different groups is difficult. Due to lack of uniformity, the comparison of data and efficacy of therapeutic measures is difficult to report. Hence, an ideal index, which is simple to understand and use, clear in its scoring criteria and demonstrably reproducible is lacking. Most of the indices proposed are not sensitive enough to monitor all the severe changes in the tooth wear clinically.
Eccles  classified lesions broadly into early, small, and advanced types. This classification was later refined and expanded with greater emphasis on the descriptive criteria.  It was then presented as a comprehensive qualitative index, grading both the severity and site of erosion. It is considered as one of the cardinal indices from which others have evolved. This classification breaks down into three classes of erosion, denoting the type of lesion, assigned to four surfaces, representing the surface where erosion was detected. However, this system is time consuming.
Greater accuracy was introduced by Xhonga and Valdmanis  , who divided erosion into 4 levels by using periodontal probe: None, minor (less than 2 mm), moderate (up to 3 mm), and severe (greater than 3 mm). They further differentiated types of erosion by morphologic descriptions such as wedge, groove, saucer, and atypical. However, they did not address the problem of inter- or intra-examiner variability. 
Smith and Knight proposed the Tooth Wear Index (TWI)  , which is simple to use clinically. However, it takes a long time to apply to a whole dentition. Also, the amount of data generated through this index is huge enough to require computer assistance if it has to be used for research work. A simplified version of TWI was given by Bardsley et al.  when carrying out epidemiological studies on large number of adolescents in North West England. However, there was some debate as to the significance of dentinal cupping and diagnosing dentine exposure in epidemiological field study using this index. 
Erosion index according to Lussi  , which is a modification of the index given by Linkosalo and Markkanen  , is a simple index grading the severity relating to the involvement of dentin. The erosion index created has been used widely by European workers to score the facial, lingual, and occlusal surfaces of all the teeth except the third molars. Khan et al.  classified dental cervical lesions and reported their association with occlusal erosion and attrition. He reported that cervical lesions are of following types: C1 - shallow cervical lesion, Cg - grooved cervical lesion, Cw - wedge-shaped lesion, Cr - the cervical restoration, Co - no cervical lesion.
A morphology-based classification has been proposed by Micheal et al., which classifies the abrasion cavities into five different categories: 'shallow', 'concave', 'wedge-shaped', 'notched', and 'irregular'. However, it does not clarify on the location and severity of the lesion.  Various other indices were reported like Ryge and Snyder's system  and Larsen's system.  However, they are all time-consuming and complicated and give an impression of a cumbersome system for grading tooth wear.
Bardsley in 2008 reported that there is not one ideal index that can be used for epidemiological prevalence studies, clinical staging, and monitoring, and it may be necessary to accept that one simple index does not exist to meet all the requirements of both clinical and research teams. 
In view of the above facts, there is a need of a simple classification to identify and grade the severity of cervical abrasion. Also, it should standardize and aid in the diagnosis and treatment planning for the condition. The classification system mentioned here is more comprehensive and uncomplicated. It identifies the severity of the lesion along with its location on the tooth or root surface [Table 1].
| Evaluation of the Hypothesis|| |
The hypothesis discusses the drawbacks of the different classification systems already available in dental literature. With advancements in knowledge, better classification systems are needed for diagnosis and determining the treatment plan for any particular condition. Hence, the classification criteria proposed by the author will easily identify, localize the area of involvement, and also grade the severity of dental cervical abrasions [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] and [Figure 6]. This system of classification can be easily incorporated into a format for noting indices for easy understanding and data recording during case-history taking and treatment planning [Table 2]. As the proposed classification system is simple to understand, easy to use and less time-consuming, it can be a good tool for use during epidemiological surveys and also clinical studies.
|Figure 1: Showing Class A Type I with tooth no.15, 43 and Class A Type II with tooth no. 14|
Click here to view
|Figure 3: Showing Class A Type IV with tooth no. 33, 34 and Class A Type II with tooth no. 24, 25|
Click here to view
|Figure 5: Showing Class C Type I with tooth no. 43 and Class C Type II with tooth no. 44|
Click here to view
| References|| |
|1.||Eccles JD. Dental erosion of non - industrial origin. A clinical survey and classification. J Prosthet Dent 1979;42:649-53. |
|2.||Smith BG, Knight JK. An index for measuring the wear of teeth. Br Dent J 1984;156:435-8. |
|3.||Lussi A. Dental erosion; clinical diagnosis and case history taking. Eur J Oral Sci 1996;104:191-8. |
|4.||Bardsley PF, Taylor S, Milosevic A. Epidemiological studies of the tooth wear and dental erosion in 14-year old children in North West England. 1. The relationship with water fluoridation and social deprivation. Br Dent J 2004;197:413-6. |
|5.||Khan F, Young WG, Shahabi S, Daley TJ. Dental cervical lesions associated with occlusal erosion and attrition. Aus Dent J 1999;44:176-86. |
|6.||Micheal JA, Kaidonis JA, Townsend GC. Non-carious cervical lesions on permanent anterior teeth: A new morphological classification. Aus Dent J 2010;55:134-7. |
|7.||Bardsley PF. The evolution of tooth wear indices. Clin Oral Investig 2008;12 (suppl 1):15-9. |
|8.||Eccles J. The treatment of dental erosion. J Dent 1978;6:217-21. |
|9.||Xhonga FA, Valdmanis S. Geographic comparisons of the incidence of dental erosion; A two- centre study. J Oral Rehab 1983;10:269-77. |
|10.||Ganss C, Klimek J, Lussi A. Accuracy and consistency of the visual diagnosis of exposed dentine on worn occlusal/ incisal surfaces. Caries Res 2005;40:208-12. |
|11.||Linkosalo E, Markkanen S. Dental erosion in relation to lactovegetarians. Scand J Dent Res 1989;93:436-41. |
|12.||Ryge G, Snyder M. Evaluating the clinical quality of restorations. J Am Dent Assoc 1973;87:369-77. |
|13.||Larsen IB, Westergaard J, Stoltze K, Gyntelberg F, Holmstrup P. A clinical index for evaluating and monitoring dental erosion. Commun Dent Oral Epidemiol 2000;28:211-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]