DENTAL HARD TISSUE DESTRUCTION 101 



worn away in the face of the many known injurious influences 

 within the oral environment. 



There is, however, a more obscure type of dental hard tissue 

 destruction that needs to be discussed in greater detail, namely the 

 pecuhar wasting of tooth substance which, for the moment, may 

 be best classified as "idiopathic erosion," The following subsections 

 will consider this problem from the point of view of ( 1 ) gross dis- 

 tribution, (2) microradiography, (3) histopathology, (4) tooth 

 structure, (5) oral environment, (6) general constitution, and (7) 

 clinical management. 



Gross Distribution 



The commonly held concept that dental erosion may be largely 

 attributed to mechanical friction from tooth brushing became widelv 

 accepted following a series of studies by W. D. Miller, published 

 in 1907. He based his conclusion on the observation that dental 

 erosion is much more common in modern than in ancient man. Out 

 of a total of 36,000 ancient skulls surveyed, none were said to have 

 shown typical lesions of dental erosion, whereas among twice as 

 many contemporarv individuals dental erosion was found, and was 

 claimed to be confined to those who had become introduced to the 

 use of a toothbrush. 



In retrospect, it is somewhat surprising how widely this circum- 

 stantial evidence was to be accepted, conflicting clinical experience 

 notwithstanding. Indeed, even earlier writings on the subject had 

 emphasized that the topographic configuration and distribution of 

 dental erosion frequenth' failed to conform to the destructive char- 

 acteristics that would be expected from mechanical friction of a 

 toothbrush. Figure 1 illustrates this point. Some of these photo- 

 graphs are reproductions of plaster casts from patients seen in the 

 private practice of Dr. Maurice Peters, who, in addition, has very 

 kindly provided some of the specimens that have been further ex- 

 plored in my microscopic follow-up studies reported below. 



It will be noted from the nine cases shown in Fig. 1 that a con- 

 siderable variation can exist in location and configuration of the 

 lesions. In some instances the lesions are located near the incisal 



