Dentaltown September 2022 - 15
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case study
Minimally Restoring
Severe Tooth
Surface Loss
Tooth surface loss is a common diagnosis in our patients-often unnoticed by them
but restorable and preventable going forward with the correct diagnosis and treatment. The
most common causes of this physical loss of tooth structure are erosion (usually chemical),
abrasion (toothbrush, habits, certain foods) and nighttime grinding (bruxism).
Regardless of the cause, the choice to restore this loss starts with observation of such
loss; sadly and too often, these surface losses are not diagnosed, so patients may continue
to have worsening outcomes. Many new patients who entered my practice were surprised
when I showed them evidence of such loss, especially with images from an intraoral camera.
This case was different because I'd pointed out the patient's issue for seven years before he
by Dr. Joe Whitehouse
Dr. Joe Whitehouse graduated
from the University of Iowa
Dental School in 1970. During
his career, Whitehouse
brought three other practices
into his own and adopted a
totally minimally invasive
approach to dental care. He
was a co-founder of the World
Congress of Minimally Invasive
Dentistry, serving as president for two terms.
Whitehouse also earned a master's degree in counseling,
enabling him to treat many fearful/apprehensive patients
without drugs. He has written about dealing with fearful
patients and authored articles on minimally invasive
dentistry and clinical issues dentists face.
agreed to start treatment. This can be common if patients have certain issues such as poorly
aligned, discolored or missing teeth, or other conditions they're not quite ready to address.
With his long-term goals in mind as documented at the initial examination and the
review of those goals periodically during recall hygiene appointments, the patient fi nally
decided to have the care that would address this issue. At age 42, he realized that his anterior
teeth were only going to get shorter and shorter, even though he'd been wearing a night
guard for several years. (His budget also now allowed for the care to be rendered, knowing
his dental insurance would pay for only a portion of the treatment.)
The patient presented showing severe tooth surface loss on Teeth #8, 9 and 22-27
from bruxism (Figs. 1-10). Dr. John Kois' diagnosis for this case would be a " grazer, " or
movement of the mandible left to right and backward and forward (as opposed to a " rat, "
which involves pure clenching). With the decapitation of the incisal edge enamel, the
surface loss of such a large exposed dentinal area would accelerate with more and more
dentin exposed. Placing the patient in a night guard would not impede the chemical or
abrasiveness of certain foods to further dentin loss, because of its softer makeup than enamel.
16 SEPTEMBER 2022 // dentaltown.com
http://www.dentaltown.com
Dentaltown September 2022
Table of Contents for the Digital Edition of Dentaltown September 2022
Dentaltown September 2022 - 1
Dentaltown September 2022 - Intro
Dentaltown September 2022 - Cover1
Dentaltown September 2022 - Cover2
Dentaltown September 2022 - 1
Dentaltown September 2022 - 2
Dentaltown September 2022 - 3
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Dentaltown September 2022 - Cover3
Dentaltown September 2022 - Cover4
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