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Chronic wear many times results in deposition of reparative dentin, the dark discoloration seen on this tooth. If wear is slow the tooth may survive by this mechanism. Rapid wear rarely produces a significant response and tooth vitality may be compromised.
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If the tooth is broken, or the wear occurs too fast or continues too far, the tooth will become endodontically involved. These teeth will generally have a dark brown to black center, which will allow an instrument into the canal. These teeth require either
root canal therapy or extraction.
There are instances, however, that the teeth don’t follow the above descriptions. On occasion, wear can occur quickly enough to infect the tooth, however the tooth will live long enough to lay down a protective layer of dentin before it dies. These teeth will look like a vital, worn tooth on the outside, but will be dead on the inside. The only way to tell for sure is by dental radiology. Dead teeth will have a wider root canal than their vital neighbors. For this reason, I recommend radiographs on all significantly worn teeth.
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