4 - Wear Flashcards
What is included in tooth surface loss?
- caries
- trauma
- developmental problems
- tooth wear
What is physiological tooth wear?
- normal physiological process that increases with age
- normal wear assoc with normal fx
- estimated normal tooth wear is 20-38um a year
What is pathological tooth wear?
- remaining tooth structure and pulpal health is compromised OR
- rate tooth wear that is in excess of what would be expected for the age of the patient OR
- pt experience a masticatory or aesthetic deficit
What are the different types of tooth wear?
- attrition
- abrasion
- erosion
- abfraction
Define attrition.
Physiological wearing away of tooth structure as a result of a tooth to tooth contact
Describe how attrition presents.
- lesions are on the occlusal and incisal surfaces
- early appearance as a polished facet on cusp or slight flattening of incisal edge
- progression leads to reduction in cusp height and flattening of occlsual incisal planes
- anterior clinical crown shortened
- restorations wear at the same rate as tooth tissue
- wide lateral excursion
What causes attrition?
Parafunction and bruxism/ functional movement
Define abrasion.
Physical wear of tooth substance through abnormal mechanical process independent of occlusion. It involves a foreign object or substance repeatedly contacting the tooth.
Describe how abrasion presents.
- site and pattern of tooth loss is related to abrasive element
- most common area is labial/buccal and cervical
- v shaped or rounded lesions
- sharp margin at enamel where dentine is worn away preferentially
What causes abrasion?
- tooth brushing
- habits including holding items between the teeth (pins, pipe, fishing line, thread)
- cracking nuts with the teeth
What impact does vaping have on abrasion?
- holding the vape between the teeth can cause abrasion
- the vape liquid is acidic so speeds up the process
Define erosion.
Loss of tooth surface by a chemical process that does not involved bacterial action.
What is the most common type of tooth wear?
Erosion
Describe how erosion presents.
- early stages the outer enamel surface detail is lost
- bilateral concave lesions that are shiny (unlikely chalky carious lesions)
- as progresses, dentine is exposed and is preferentially eroded leading to cupping of occlusal surfaces and incisal edges of anteriors, base of lesion does not contact opposing arch
- restorations stand proud of tooth
- no staining
What causes erosion?
- acidic drinks (also - alcohol)
- eating disorders
- medications (low pH or xerostomia)
- GORD
- rumination
- pregnancy
Define abfraction.
Loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
Describe the forces behind abfraction.
- biomechanical loading forces which result in flexure and failure of enamel at a location away from the loading
- disruption in the crystalline structure of the enamel by cyclic failure
- cracks can cause tooth structure to chip away
Describe how abfraction presents.
- v shaped lesions at cervical margin where the tooth is under tension
- sharp margin at ACJ
Cervical wear aetiology
- Multifactorial
- always with a Good OH
- mainly premolar/molar
- buccal
- abrasion mainly ( + erosion/ abfraction)
overzealous tb
What is involved in the tx care of tooth wear?
- accurate diagnosis is essential
- recognise risk factors eg diet
- grade the severity
- monitor progress of disease
- provide preventative measures
Do patients with tooth wear typically report pain?
Uncommon unless rapidly progressing or pulpally involved
What functional difficulties are reported by patients with tooth wear?
- typically that teeth are sharp (biting lips/cheeks)
- masticatory efficiency
How does PDH impact tooth wear treatment planning?
- wear treatment requires multiple visits so compliance is important
- OHI and education vital
What should you assess in the EO exam?
- TMJ for restriction of movement, clicking, crepitus
- hypertrophy of musculature
- opening for restriction( <4mm) /deviation
- overclosure
- lip line
- smile line
