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Tooth surface loss can present in a variety of ways, some of which can appear rather strange on first examination. This case report demonstrates an unusual presentation of tooth surface loss (TSL) and its subsequent treatment. This loss of hard dental tissue appeared to be affecting the whole of the patient's remaining dentition, both lingually and buccally. Detailed questioning revealed the origins of this problem which turned out to be due to excessive use of an intra-oral Miswak chewing stick.
Clinical Relevance: This article will enable clinicians to understand the importance of specific, targeted history-taking, involving a rare case of tooth surface loss as well as the use of minimally destructive restoration composites and a fibre-reinforced composite bridge.
Article
Tooth surface loss, affecting both the lingual and buccal aspects of teeth presenting as a generalized pattern, is a relatively rarely reported pathological finding. More commonly, tooth surface loss occurs mainly on the palatal aspects of teeth (eg in cases of bulimia or gastro-oesophageal reflux disease (commonly abbreviated to GORD), or on the incisal or occlusal surfaces of teeth, or a combination of both depending on the various aetiologic factors.
There are a number of different descriptions and indices of tooth surface loss, some implying a supposedly definite aetiology. In 1982, Eccles described ‘tooth surface loss’ as a pathological loss of hard tooth tissue by a disease process other than dental caries.1
The aetiological factors responsible for tooth surface loss are usually described as belonging in one of the following main categories:
Tooth surface loss can be a progressive phenomenon, but it can also present as a reflection of past habits and/or of only slowly progressive tooth surface loss.
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