The aim of this chapter is to discuss current evidence and clinical protocols for recall and maintenance in patients who have undergone non-invasive and/or invasive treatment for erosive tooth wear. There is a paucity of research and evidence for some of the suggested protocols, and some sections are based on clinical experience. Recall for patients who have undergone non-invasive treatment is either for behavioural change and/or monitoring of progression of tooth wear. Behaviour change needs to be patient centred and holistic, with an individualised plan. Recall is essential to assess adherence to any behavioural change plans and advice, as well as any change in the patient's risk category. If the patient has active signs or symptoms associated with erosive tooth wear progression, such as dentine hypersensitivity, symptomatic reflux or an active eating disorder, it is prudent to review the patient after 3 months. If the recall visit is mainly cantered around assessing progression of the wear, periods between 1 and 3 years depending on the presumed aetiology of the patient are appropriate with the current methods of assessing progression, including intraoral scans and various indices. The main aims are to identify the risks, reduce the risks and ensure the progression of wear is stabilised. In cases where invasive treatment has been carried out, the non-invasive recall and maintenance still apply. In addition, the recall visits entail repair or replacement of restorations. In general, the most minimally invasive approach that is accepted by the patients should be attempted, such as monitoring stained margins, repair of restorations to prolong the lifespan of the restoration or in some cases progression to more invasive restorations, all depending on the patient's wishes and the goal of improving quality of life.
The dynamic interplay of the oral fluids with the tooth surface is of essential relevance for the modulation of the de- and remineralization of tooth hard substances. It is generally accepted textbook knowledge that the buffering and clearance properties of the saliva are key factors in the prevention of erosive mineral loss. This becomes especially evident when the patients suffer from xerostomia. Furthermore, biomolecules in the oral fluids ensure the formation of the pellicle layer on all solid surfaces. While the enamel pellicle has been shown to diminish erosive attacks to a certain extent, it is unclear if the dentinal pellicle yields the same efficiency. In this context, two aspects seem to be marginalized in research: the dentine surface and the impact of protein adsorption and infiltration in demineralized tooth structures, despite the fact that both are essential for the understanding and modulation of erosive processes. Successful and sustainable prevention strategies are only possible if we understand these dynamic interactions. Therefore, future research should focus on the interaction of proteins with dentine and enamel during repeated de- and remineralization processes.
Erosive tooth wear is a gene-environmental model. It requires the exposure to acids, typically from the diet or from the gastric content of the host, and shows variation among individuals and populations, which suggests it to be determined by more than one gene, each with small individual effects. This chapter expands the discussion that supports the assumption that a genetic component modulates the expression of erosive tooth wear.
Any preventive measure or behaviour change from the patient can only be based on a thorough assessment of the factors involved in erosive tooth wear (ETW). Patient assessment, in turn, runs hand in hand with a good detection of the ETW lesions and their progression. This chapter presents an overview of how to assess ETW lesions, monitor their progression and assess the factors related to the condition, in order to discuss preventive measures. Clinical assessment can be made with clinical indexes, like the basic erosive wear examination, while monitoring can also include accessory methods, like photographs, casts, intra-oral scanning, etc. Ideally, ETW lesions should be detected in their early stages, which will then prompt the health professionals to identify the factors involved in the condition. For that, dental health professionals can make use of dietary assessments and verify salivary parameters, eating disorders and gastroesophageal reflux disease. Susceptible patients, like those who use drugs and specific medications and/or who are exposed to environmental or occupational threats, should also be assessed. Once the factors are identified to each individual case, preventive measures can then be tailored to each patient, to hinder the progression of lesions and/or to deal with any dentine hypersensitivity arising from exposed dentine.
