Applying aetiology to txt plans Flashcards
What are main aetiology of tooth wear?
- Attrition
- Erosion
- Abrasion
- Combo of these
- Idiopathic unknown
What is pathophysiology of tooth wear?
- Age is physiological and older people are going to have some wear
- Pathophysiology is the wear that is more than what is expected of them at their age
Why is aetiology of tooth wear important ?
- Attempt to reduce further wear
- Plan for problems, contingencies and failure
- Allows you to be realistic with yourself and pt
- Identifies wider medical and well being issues and allows signposting to correct facilities
- Acts as prognostic indictor (bruxist)
- Enhances consent process
- Aids clinical diagnosis and txt planning
Attrition tooth wear is a spectrum rangin from physiological wear to bruxist. What are some modifying factors that can enhance the wear?
- Lack of posterior teeth
- Occlusion (certain teeth take heavy load )
- Restorations (e.g. lots on one side can cause more wear on opposite side natural teeth)
- Erosion and abrasion in combo or isngular
- Stress and anxiety
What are some common features of a Bruxist?
- Significant wear throughout dentition
- Repeated restoration failure
- Root fractures
- Often onset in early adulthood
- Rapidly Progressive
What are some common features of physiological tooth wear?
- Canine tips flat
- Tooth wear on anterior portion of teeth
- with elderly like 50+
- natural process
Why is lack of posterior support considered a modifying factor to attrition?
- No posterior support leads wear to be more extensive
- It is often more rapidly progressive as well
- Common in a shortened dental arch with lack of post support (gives reduced occlusal pairs)
- Physiological wear becomes pathological
Why is occlusion considered a modifying factor of attrition?
- Wear can be caused by nature of occlusion and is often compounded by parafunction
- Deep overbite shows mainly lower incisor wear but also a little bit on the palatal upper incisors
- Edge to edge occlusion gives localised wear anterior teeth (usually gives lack of posterior support)
Why are restorations considered to be a modifying factor of attrition?
- Porcelain particular if unglazed or unpolished is quite abrasive to opposing arch of natural teeth giving wear
At early stages of a tooth wear pt where there is no evidence of obvious wear we may see evidence of what? Give some examples of this
- Parafunction
- Multiple cusp fracture
- Multiple cracks around restoration
- Root fractures in unrestored teeth
What can contribute to the rate of progression of erosion?
- Extrinsic and Intrinsic acid factors
- Modifying factors like
- Lifestyle like drinking or stress
- Psychosocial
- Amount and frequency of drink etc sipping, with straw etc
- Level of control
What extrinsic factors can affect rate of progresion of erosive tooth wear?
- Carbonated drinks
- Sports drinks
- Alcoholic acidic drinks like cider
- Citrus drinks
- Acidic fruits
- Acidic sweets
- Pickles
- Drugs (metaamphetamines)
What intrinsic factors can alter the rate of progression of erosive tooth wear?
- Eating disorders like bulimia nervosa
- GORD
- Medical conditions like uncontrolled diabetes and barest oesophagus
What are the common erosive features of carbonated drink intake?
- Incisal erosion on upper centrals (holding can or bottle directly onto teeth)
- Cupping on lower molars
- Palatal erosion on upper incisors
- Gives tooth sensitivity due to rapid erosion
- Interproximal caries and buccal white spot/brown caries
What are some common erosive features of pts with eating disorders?
- Palatal erosion on upper teeth
- Polished restorations
- Erosion around restorations
- Sensitivity
- Caries
- Altered taste sometimes
- Halitosis sometimes
- Soft tissue change rarely
What abrasive behaviours can alter the rate of progression of abrasive toothwear? What is different about this tooth wear to the others?
- toothbrush abrasion
- Oral self harm
- Tongue studs lingual of lowers
- Occupational
- Unusal habits
- Different as can easily modify the rate of progression by eliminating these factors
Your pt has toothbrush abrasion. What issues do you need to consider when examining a pt?
- Is it localised or generalised
- Frequency and duration
- Bristle and toothpaste abrasiveness
- Electric v manual
- Brushing technique instruction
- Part of a combo wear problem i.e. eating disorder
- Part of stress or anxiety related problems
Tooth wear is said to have what in terms or rate and progression?
- A synergistic rate of wear progression (work together)
What are the common combinations of toothwear aetiology seen?
- Erosion (intrin and extrin) , attrition and abrasion
- Alcoholism and drug abuse- Eating disorder
Erosion (extrinsic) and attrition
- Bruxist with poor diet
Erosion (Intrin and extrin) and attrition
- Bruxist with poor diet and GORD
Sometimes a comprehensive history and exam does not provide an aetiology. What can you do?
- Often shows unusual wear patten
- pt may know aetiological but wont tell you
- If planning txt plan warily and communicate a guarded prognosis - may fail
History taking in tooth wear cases can be challenging. As an individual how should you address this section?
- Be comprehensive
- be compassionate
- Unconditional positive regard
- Show patience
If you know the aetiology you can now plan for the pt. What may be included in a plan?
- Individualised preventative plan
- reinforcement of OHI
- Signposting / referral to other health and social care professionals
- Review before definitive plan
What are common preventative advice as a broad scope?
Fluroide
- High dose toothpaste
- Alcohol free mouthwash
Dietary modification
- Frequency and quantity of particular foods or drinks
- Method of delivery i.e. straw
- Elimination and addition
Remineralisation
- Tooth mousse
Sugar free gum
What are some interventions to control aetiology of tooth wear?
Toothbrushing instruction
Splint therapy
Signposting:
- CBT
- Hypnotherapy
Referral:
- GMP
- Psychiatrist
- Social services
Failure to control aetiology may result in what?
- Failure to correct or prevent further tooth wear
This is an example of tooth wear case. What history would you take. On examination what can you see?
What special test would you want?
What are your diagnoses?
History
- C/O
- HPC
- PMH, gastro issues, any eating disorders
- PDH, toothbushing habits , toothpaste, grind, habits , diet
- SH (job, stress, anxiety
Exam
- Tongue piercing
- Deep overbite non traumatic
- Class I incisors
- Class 1 canines
- Translucent centrals
- Cupping defects on centrals (looking like erosion)
- Caries 12 mesially
- Mild attrition upper incisors and lower incisors including 33 into dentine
- Attrition on palatal canines
- Severe erosion premolar and molars lower with total loss of occlusal enamel
- Defects of restorations upper with erosion surrounding it
Special test
- Bitewings to assess caries, bone levels and extent of wear
- PA
Diagnoses
- Extrinsic acid with combo of attrition and maybe intrinsic depending on medical conditon
Preventative plan
- Modify diet with advisory what to change
- OHI
- Fluoride toothpaste ? or mouthwash
- If eating disorder consider signposting pt
- Is pt going to address problems , review
- Prognosis of molar poor if aetiology not underwarps
In tooth wear pts what as a dentist do you need to be mindul of?
- Expect failues and cycles of restoration in tooth wear pts
