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Tooth wear is an increasing problem for general dental practitioners. Attrition is associated with bruxism, primarily a stress-related condition that is difficult to manage dentally. Direct composite restorations are frequently used to restore the worn anterior dentition. Soft occlusal appliances (night guards) are often prescribed in bruxism, despite debatable clinical benefit. Bilaminar (dual-laminate) splints or night guards are composed of two distinct layers of ethylene-vinyl acetate; a soft inner and a harder outer layer. These occlusal appliances are cost-effective to construct, easy to fit and offer greater resistance to occlusal forces than entirely soft occlusal appliances. Patient compliance is excellent. Bilaminar night guards are proposed as an alternative occlusal appliance to prevent further attritional tooth wear from bruxism when TMD is absent and for protection of composite placed to restore the worn dentition.
CPD/Clinical Relevance: The soft occlusal guard is widely used in dentistry but lacks durability and cannot be adjusted. To prevent further attrition and protect restorations, the use of a bilaminar or dual laminate material is advocated in cases of bruxism.
Article
Tooth wear is an increasingly common problem. The Adult Dental Health Survey (2009) reported an increase of anterior tooth wear from 66% in 1998 to 76% of all examined adults in 2009.1 Moderate wear increased from 11% to 15% over the same period. Of particular concern is the reported rise within younger age groups; with 16–24 year-olds displaying a 3% increase in moderate wear to 4% since 1998.2 This trend is likely to lead to more significant management problems in the future.3
Tooth wear can result from multiple processes. A diagnosis of attrition, erosion or abrasion in isolation should only be considered when there is significant clinical or historical evidence to substantiate the diagnosis.4 In reality, tooth wear is often a combination of these diagnoses.5 Attrition is closely related to bruxism, which is widely regarded as a stress-related parafunctional activity. Bruxism and attrition remain a source of great concern for many patients. The principal complaint and driver to seek treatment in 59% of 290 patients referred to a UK teaching hospital for tooth wear was poor aesthetics, followed by sensitivity (40%), functional problems (17%) and pain (14%).6 A similar study reinforced these findings, with aesthetics the primary concern for 54% of patients.7
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