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CSP3 > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

Describe how to diagnose tooth wear?

A

History
Examination
Special tests

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2
Q

Name the 4 types of tooth surface loss?

A

Erosion
Abrasion
Attrition
(Abfraction)

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3
Q

What are the useful questions to take during the history to get an idea about tooth surface loss

A
  • When did you first notice it?
  • Are the teeth sensitive – if so, when and with what?
  • Have the teeth changed colour?
  • Have you chipped bits from the teeth
    Medical history
    Diet history - general overview, vegetarian, drinks, fruits etc
  • Are you aware of grinding or clenching your teeth?
  • Do you ever wake up with soreness tenderness over your cheeks and lower jaw?
  • Can you chew alright?
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4
Q

What to assess on an E/O exam?

A

Symmetry
Centre-line
Lip line – smiling and at rest

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5
Q

What to assess on an I/O exam?

A

Soft tissues, plaque control, gingival condition, BPE
The teeth - missing teeth, degree of previous restoration, types and size of restorations, occlusal relationships

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6
Q

Name 3 special tests for tooth surfce loss?

A

Diet Diary – 3 days duration
Referral to General Medical Practitioner – with specific questions
Use of study casts
- easier to observe wear on dry stone casts
- may be useful as base-line record

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7
Q

What are the management techniques for tooth surface loss?

A

Prevention and monitoring
Restoration of tooth or teeth
Replacement of missing teeth

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8
Q

Name the managament techniques for erosion?

A

Remove or control the erosive source
Control symptoms
Increase resistance to dissolution
Base-line records and monitoring
Restoration
Extraction

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9
Q

What treatment can be used for the management of pain and sensitivity?

A

Sensodyne – potassium nitrate – induces high mineral content
- Stannous fluoride – blocks dental tubules
Tooth Mousse – Amorphous calcium phosphate
- unfilled resin – forms resin plugs in tubules

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10
Q

How to decide whether to monitor or to restore?

A

For certain types of wear, restorations may be protective
The restoration m ust be present in sufficient bulk to prevent its mechanical failure
Restorations that remove tooth structure are less desirable but may be necessary

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11
Q

Characterisitics of acid erosion of teeth?

A

Wear of incisal edges - jagged incisal edge
Cupping of the occlusal surface

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12
Q

What is the definition of erosion?

A

The progressive loss of tooth substance by chemical processes that do not involve bacterial action

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13
Q

What is the defintiion of perimolysis?

A

acidic erosion of the teeth as result of chronic acid regurgitation

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14
Q

What is the defintion of abrasion?

A

An abnormal wearing away of the tooth substance by causes other than mastication

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15
Q

What is the definition of abfraction

A

The pathologic loss of hard tooth substance caused by biomechanical loading forces. Such loss is thought to be due to flexure and chemical fatigue degradation of enamel and/or dentine at some location distant from the actual point of loading

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16
Q

What is the definition of attricion?

A

The mechanical wear resulting from mastication or parafunction, limited to contacting surfaces of the teeth

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17
Q

Describe te abrasiveness of dental materials from greatest to least?

A

Unglazed porcelain
Glazed porcelain
Cast chrome-cobalt
Cast nickel-chrome
Cast gold
Composite resin
Glass ionomer cement
Acrylic resin

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18
Q

Tooth wear in primary dentition?

A

Is a frequently observed phenomenon particularly as the teeth become close to exfoliation

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19
Q

What are the mangement options for anterior primary teeth tooth surface loss?

A

Restoration
Extraction

20
Q

What is the definition of bruxism?

A

The parafunctional grinding of teeth
Bruxism, the occlusion and temporo-mandibular disorders
Linked to occlusal interferences

21
Q

Describe a posterior interference that could cause bruxism?

A

Facet:
A small planar surface on any hard body

22
Q

Name the treatment options for bruxism?

A

Occlusal appliances:
- Assist in determining RAP
- Protection of teeth and restorations
- Management of TMD’s

23
Q

Describe the effects of an occlusal splint?

A

Direct protection
Reduce elevator activity
Placebo

24
Q

Describe the occlusal design for an occlusal appliance for bruxism?

A

Multiple even contacts in RAP
Anterior guidance
Separation of posterior teeth on mandibular movement

25
Q

Describe the presenting features for erosion?

A

Sensitivity
Pain
Chipping of the incisal edges
Tooth fracture
Darkening of the teeth
Loss of surface anatomy
Increased incisal translucency
Loss of the incisal edges
Increasing areas of exposed dentine
Pulpal exposure

26
Q

Can combinations of tooth surface loss occur?

A

Erosion + Attricion
Combinations are frequent but there is always a predominant aetiology

27
Q

What is the key need for any tooth preparation?

A

Tooth height
- aestehtic and occlusal form
Facilitates retention and reisstance form and control of cuspal positions

28
Q

Describe a worn tooth?

A

Loss of structure
Lack of crown height
Broader functional surfaces

29
Q

What is the compensation for tooth wear?

A

Vertical dimension of occlusion is maintained
Sometimes but rarely, there is space available at ICP

30
Q

What are the probelms with gaps in the dentition?

A

Control of occlusal form is difficult
Particularly cusp position

Multiple crowns placed on short teeth
- result in broad flat occlusalm surfaces which compromise occlusal stability

31
Q

Name the problems caused by worn/short teeth?

A

Retention and Resistance
Control of occlusal form

32
Q

Name ways of facilitating increased crown height?

A
  • Surgical crown lengthening whilst maintaining the existing occlusal vertical dimension
  • Changing the jaw relationship whilst maintaining changing the occlusal vertical dimension
  • Changing the jaw relationship and increasing the occlusal vertical dimension
33
Q

Describe the restorative management of short maxillary anterior teeth?

A

Addressing problems of:
- Potential lack of retention and resistance
- Poor aesthetics due to a lack of crown height

34
Q

What can be done to treat short teeth at the exisiting occlusal vertical dimension?

A

orthodontic treatment + subsequent crown lengthening surgery

35
Q

Name the 3 ways to create space to allow restorations to be placed?

A

Occlusal Adjustment
- Changing the jaw relationship whilst maintaining changing the occlusal vertical dimension
Increasing the Occlusal Vertical Dimension
- which changes the jaw relationship
Localised Relative Axial Tooth Movement
- which changes the occlusal vertical dimension

36
Q

What conditions need occlusal adjustment?

A

Chipping of incisal edges
- No space to allow restoration

In some patients, the retruded axis position is posterior to the intercuspal position

37
Q

How do we make use of the retruded axis positon (RAP)?

A

From here the mandible is deflected anteriorly
To eliminate the tooth contacts on the retruded arc of closure which deflect the mandible into a more anterior path of closure

38
Q

Does tooth wear lead to loss of occlusal vertical dimension?

A

Not if opposing teeth make contact
They continue to erupt and bring the alveolar bone and gingival tisues with them leading to an increased display of soft tissues
In the absence of significant tooth wear, facial height increases throughout life
Occlusal wear leads to loss of stability

39
Q

The Vertical Dimension of Occlusion? - how critical is it?

A

“Promiscuous change” - should be avoided
In the absence of significant tooth wear, facial height increases throughout life
25-45 yrs, facial height increased 1.6mm
Rest position had a range of 11mm
Moderate changes in the vertical dimension of occlusion are well-tolerated

40
Q

Describe the traditional way to track vertical dimensional changes in occlusion?

A

Occlusal analysis
Occlusal splint therapy
Diagnostic wax-up - OVD increased using temporary coverage

41
Q

What are the aims to retain vertical mension of occlusion?

A

Determining a stable mandibulo-maxillary relationship

42
Q

Explain the process of Localised Relative Axial Tooth Movement?

A

Rehearsing the outcome with temporary resin
Good isolation is essential
Begin by forming the palatal against a silicone putty index
Complete the central incisors then move on to the laterals
Facial view:
- Full occlusion is restored by eruption of the teeth which are out of contact and intrusion of those which are.
- In young patients, eruption is the dominant movement.
- In older patients, there is less eruption and achieving full contact is more reliant
on intrusion
Palatal view:
- Re-establishing full occlusion takes between 6 weeks to 6 months depending on the age of the patient and the amount of movement required

43
Q

What other techniques are used for tooth surface loss treatment?

A

Composite build ups:
- Make use of an index from the diagnostic wax-up to control initial form

44
Q

Direct composite resin + Relative axial tooth movement?

A

Has radically changed the approach to restoring worn teeth
- upper labial anteriors, then lower anteriors and finally palatal surface of upper anteriors

45
Q

What is the definition of the Dahl effect?

A

Facial view
- Full occlusion is restored by eruption of the teeth which are out of contact and intrusion of those which are.
- In young patients, eruption is the dominant movement.
- In older patients, there is less eruption and achieving full contact is more reliant on intrusion
Palatal view
- Re-establishing full occlusion takes between 6 weeks to 6 months depending on the age of the patient and the amount of movement required

CSP3 (6 decks)

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