Managing tooth surface loss

This chapter will emphasise the need to:Be aware that most patients diagnosed with tooth surface loss (TSL) do not need to be restored, at least in the short term, but need to be advised how best to control causative factors (e.g. extrinsic erosion, intrinsic erosion, and bruxism)Liaise with the patient's doctor to manage intrinsic erosion, e.g. gastro-oesophageal reflux disease (GORD) or bulimia. The patient must accept the risk of early failure if restorations are provided before the medical condition is controlledRecord baseline study models to monitor TSL longitudinallyImplement restorative treatment where there are major aesthetic concerns and uncontrolled dentine sensitivity or where further TSL would compromise restorabilityConsider restoring anterior teeth using composite. A large composite can later have its buccal surface covered with a ceramic veneer (sandwich technique)Be realistic about restoring posterior teeth and choose an appropriate material to cope with higher occlusal forces, particularly in bruxists. If teeth are to be crowned, patients need to be aware of the risk of pulp damage and its consequencesPlan reconstructions according to whether TSL is localised or generalised. Generalised wear is more difficult; space is created by increasing the occlusal vertical dimension