8 - Tooth wear 1 Flashcards
Applying aetiology to treatment plans and dentures/overdentures for rehabilitation
What are the main aetiologies of tooth wear?
- attrition
- erosion
- abrasion
- combination
- unknown
Why is understanding the aetiology of tooth wear important?
- attempt to reduce further wear
- plan for problems, contingencies and failure
- identify wider medical/wellbeing issues
- prognostic indicator
- informed consent
What are the modifying factors of attritive tooth wear?
- lack of posterior support
- occlusion
- restorations
- stress and anxiety
What are common presentations of bruxism?
- significant wear throughout dentition
- repeated restoration failure
- root fractures
- early onset in adulthood
- progressive
What are common presentations of physiological wear?
- wear in line with the patient’s age
- incisal cupping in older patients
- loss of canine cusp in older patients
What are the common features of lack of posterior support?
- progressive wear on remaining anterior teeth
- wear is more extensive due to all masticatory force being placed on anterior teeth
How does a deep overbite present with bruxism?
Wear on labial surface of lower incisors
How does an edge to edge occlusion present with bruxism?
Localised wear on contacting incisors
What material causes significant wear when used in restorations?
Porcelain
What are the modifying factors in erosive tooth wear?
- lifestyle
- amount and frequency of erosive agents
- level of control
- psychosocial
What are extrinsic sources of erosive agents?
- carbonated drinks
- sports drinks
- alcoholic drinks
- citrus drinks
- acidic sweets
- pickles
- drugs
What are intrinsic sources of erosive agents?
- eating disorders
- GORD
- other medical conditions
What are common features of tooth wear caused by carbonated drinks?
- incisal erosion on upper centrals
- cupping on lower molars
- palatal erosion on upper incisors
- sensitivity
- interproximal caries
- buccal white spot caries
What are common features of tooth wear caused by an eating disorder?
- palatal erosion on upper teeth
- polished restorations
- erosion around restorations
- sensitivity
- caries
- altered taste
- halitosis
- soft tissue changes (eg abrasions under tongue)
What are abrasive behaviours?
- over toothbrushing
- oral self harm
- tongue studs
- occupational
- unusual habits
What are common causes for a combination of tooth wear types?
Erosion (both), attrition and abrasion
- alcoholism and drug use
- eating disorder
Extrinsic erosion and attrition
- bruxist with poor diet
Erosion (both) and attrition
- bruxist with poor diet and GORD
Why is lack of posterior support a common problem?
- denture intolerance
- denture refusal
- supervised neglect (ie not told to get a denture)
Define an overdenture.
Removable prosthesis that rests on one or more remaining natural teeth, roots of natural teeth and/or implants
What are the advantages of overdentures?
- correction of occlusion and aesthetics
- tooth wear management
- preservation of ridge form
- proprioception
- denture retention
- can incorporate precision attachments
- avoids XLA
- psychological benefits
- transition to edentulism
What are the disadvantages of overdentures?
- need good OH
- increased caries/perio problems
- denture fracture
- discomfort or infection risk
- potentially future XLA more traumatic
What is involved in the care of overdentures?
- good OH
- fluoride toothpaste application and brushing of roots
- regular exams
- denture hygiene
What are transitional dentures?
Can be used to increase OVD in cases where poor posterior support to create space for restorations
How can denture teeth be modified for a bruxist?
- CoCr backing of teeth
- CoCr palate with acrylic post dam
- overlay denture to act as splint
What is the purpose of “simplifying small saddles”?
The use of bridgework to remove single tooth additions to dentures
