This final article in a series of three covering general practice aspects of erosion-abrasion presents a three-phase system for clinical management of erosive-abrasive damage. The first phase comprises pre-restorative case evaluation, initial measures to control factors predisposing to continued erosion-abrasion and where necessary the provision of acrylic overlays to restore facial height. In the second phase the teeth are systematically restored using an acid-etch composite resin technique; guidance for comfortable occlusion is provided by the patient acceptance method. The third phase comprises follow-up, including monitoring of salivary and bacteriological parameters, maintenance of the restorations and modifications of preventive measures necessary to preserve the dentition restored by multiple composite therapy. Modern oral physiological concepts and recent developments in multiple composite therapy and erosion control are discussed.

The development and progression of cervical lesions have not been thoroughly documented. Clinically, two morphologically distinct forms, saucer-or wedge-shaped, have been described. In this study, the micromorphology of manifest cervical lesions was documented in six subjects, by SEM replication and microendoscopy. Optoelectronic recordings were made of extreme mandibular lateral excursions. Salivary parameters were evaluated and a detailed case history, including oral hygiene and dietary habits, was taken. Lesions of varying severity could be observed in the same subject. Longitudinal fractures of the enamel were common. The dietary analyses were uneventful and salivary values were normal. No correlation was found between brushing habits and the location and severity of the lesions. The optoelectronic recordings, however, indicated a possible correlation between irregular lateral excursion and the severity and location of the lesions, with a tendency for fewer and less severe lesions on the preferred chewing side. The results have indicated some areas of interest for future studies applying non-invasive observation methods.

Tooth surface loss by erosion presents a challenge to the general practitioner in terms of identification of patients at risk, differential diagnosis from attrition and abrasion, evaluation of aetiological and modifying factors in Individual patients and in the clinical management of a progressively destructive pathological process. The guidelines presented in this paper, based on current research findings, were developed in the Department of Cariology, Karolinska Institute, Stockholm, to provide dentists with routines suitable for use in general practice.

The changes in upper and lower resting lip pressures following extension and flexion of the head and at changed mode of breathing were studied in a sample of 15 adults with Class I molar relationship. The lip pressure was measured with bonded strain gauge transducers on the upper and lower central incisors. The transducers could be calibrated directly in the subject's mouth. The upper and lower lip pressures during natural head posture had a mean value of 3.91 g/cm2 and 8.58 g/cm,2 respectively. The mean values of the differences between pressures obtained during natural head posture and during 5 degrees, 10 degrees, and 20 degrees of extension showed a continuously, highly significant increase in pressure. During 5 degrees, 10 degrees, and 20 degrees of flexion, the upper lip pressure continuously decreased with highly significant values. Changes in the lower lip pressure during flexion were difficult to measure because of intense muscle activity. A significant decrease was shown for the difference in upper and lower lip pressures between nose breathing and mouth breathing, whereas there was a significant increase in pressure when the subject extended the head 5 degrees during mouth breathing.

During the past decade much interest has been focused on disorders of the TMJ. The etiology appears to be multifactorial, with signs and symptoms difficult to evaluate and radiologic investigations insufficient. This review attempted to analyze current diagnostic tools. The recent introduction of various techniques promises optimism for this diagnostic and therapeutic challenge.