Tooth surface loss fallacies and quandaries: What? Why? When? How?

Tooth surface loss (TSL) in young people is increasingly prevalent and is often mismanaged by over-reliance on a ‘measure, advise and monitor’ strategy and adherence to dogmatic thresholds specified in a tooth wear index called BEWE. There is a fundamental difference between caries and tooth surface loss/tooth wear. Unlike caries, erosion (‘chemical’)and attrition/abrasion (‘mechanical/physical’) both involve irreversible loss of the matrix of the tooth, meaning that the matrix is no longer there to remineralize with anything. Delaying intervention by using preventive and reparative additive composite risks avoidable loss of valuable ‘dental capital’. Localized wear patterns often reflect easily identifiable aetiologies, particularly when teeth are exposed to multiple attacks by dietary or stomach acids (e. g. GORD, bulimia), and being confident in doing that quickly should prompt early, targeted management. Additive direct resin composite provides a conservative, renewable and cost-effective means of protecting vulnerable ‘dental capital’ while improving appearance and function. Appropriate pragmatic intervention to preserve their dental capital protects patients ethically, biologically and legally. CPD/Clinical Relevance: This article challenges the ‘BEWE measurement, advise and monitor’ approach and advocates a pragmatic, preventive, additive-composite approach to protect patients’ remaining ‘dental capital.’