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CSA clinical aspects > CSA tooth wear > Flashcards

CSA tooth wear Flashcards

1
Q

What is tooth wear aka?

A

non carious tooth loss

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2
Q

Is tooth tissue loss normal ?

A

yes

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3
Q

what is tooth wear?

A

is pathological when rate of loss is excessive

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4
Q

What problems can it lead to?

A

aesthetics function or sensitivity

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5
Q

What is tooth wear caused by >

A

EROSION
ABRASION
ATTRITION

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6
Q

What is erosion?

A
  • irreversible, progressive loss of dental hard tissue by acidic chemical process not involving bacteria
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7
Q

What is abrasion ?

A

 abnormal wearing of tooth substance or a restoration by mechanical process other than tooth contact
 Abrasive agents in toothpaste causes abrasion while tooth brushing

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8
Q

what is attrition ?

A

 loss of tooth substance or restoration caused by tooth to tooth contact

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9
Q

Why does erosion increase in young in UK?

A

acid rich diet

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10
Q

What can tooth wear expose on tooth surface?

A

dentine

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11
Q

What can erosion be?

A

extrinsic (external) or intrinsic (from patient)

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12
Q

What are multifactors of erosion

A

TIME
EXTRINSIC
HOST
TOOTH

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13
Q

What are host factors?

A

saliva
anatomy
reflex
medical

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14
Q

what are extrinsic factors?

A

diet
lifestyle
meds
enviro

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15
Q

What are intrinsic acid factors (regurgitation erosion)

A
  • Gastro-oesophageal reflux (GOR)
  • Vomiting
  • Ruminant eating
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16
Q

What is Gastro-oesophageal reflex?

A

o Sphincter incompetence – doesn’t stop acid coming up
o Increased gastric pressure AND volume
o When someone has big meal & lots to drink, get increased acid reflux

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17
Q

What are GOR symptoms ?

A
  • Heartburn
  • Retrosternal discomfort
  • Epigastric pain
  • Dysphagia
  • Chronic cough
  • Sore throat
  • Hoarseness
  • Sour taste at the back of the throat
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18
Q

What are eating disorders?

A

anorexia

bulimia

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19
Q

what oral hygiene products can be acidic?

A

o Mouth washes

o Saliva substitutions

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20
Q

What medications can be acidic diet sources?

A

o Vitamin C
o Asthma inhalers
o Hydrochloric acid  this is rare
o Those affecting saliva quality/quantity

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21
Q

What factors involved in dietary erosion?

A

o amount of substance ingested
o frequency of consumption
o method of consumption  through a straw
o timing of consumption

22
Q

What are predisposing factors to tooth wear?

A 
•	Saliva 
o Flow rate is low
o Buffering capacity is impaired
o Presence of salivary mucins 
o Clearance rates from diff oral sites
23
Q

What is the clinical presentation of erosion at anterior teeth?

A

o loss of surface anatomy & smooth enamel surface
o Incisal edges increase in translucency
o Incisal edges chip away
o Palatal hollows
o Areas of absence of enamel
o Exposure of pulp
o Intrinsic affect palatal surfaces, extrinsic affect the labial

24
Q

What is the clinical presentation of erosion at posterior teeth?

A 
o Loss of surface anatomy
o Cuspal cupping 
o “proud restorations”
o Darkening of colour
o Pulpal exposure rare in permanent teeth
25
Q

How is erosion different from caries?

A

In erosion, leads to demineralisation and loss of organic matrix but no loss of matrix in caries

26
Q

What is attrition?

A

enamel and dentine wear away at same rate

27
Q

What forms during attrition ?

A

secondary dentine

28
Q

What can attrition lead to?

A
  • possible masseteric hypertrophy > pain in muscles of mastication
  • risk of tooth mobility
29
Q

What is bruxism ?

A

common in response to stress
• Associated tongue scalloping and/or cheek ridging in active cases
• Masseteric hypertrophy in severe cases

30
Q

What are factors in tooth abrasion ?

A 
o Tooth brushing
o Abrasive dentifrices  smokers toothpaste that used to remove stain 
o Abrasive food particles 
o Piercings
o Habits
31
Q

What are clinical presentation in mouth of abrasion?

A

o Mainly cervical
o Sharply defined margins
o Smooth hard surface
o More rounded & shallow if associated with erosion

32
Q

What is a non carious cervical lesion?

A
  • saucer shaped or groove wedge shaped lesions

• Increasingly elderly dentate population

33
Q

What is abfraction?

A

• Occlusal forces cause compressive and tensile stresses, concentrated at cervical region of tooth

34
Q

What does abfraction cause>

A

micro fracture of cervical enamel rods

  • defects maybe seen sub gingivally
  • deep V shape notch seen
35
Q

What is retention of composite like in cervical lesions?

A

poor

36
Q

how to check severity of tooth wear?

A
  • Is it causing any symptoms? / sensitive?
  • Is it affecting enamel/dentine/pulp
  • Loss of crown height
  • Structural integrity compromised?
  • Aesthetic concern?
37
Q

Difficulties from severely worn teeth ?

A 
Lack of tooth tissue
pulpal problems
aesthetic compromise
lack of space for restor.
occlusal changes
soft tissue change
aetiological factors
38
Q

What are the clinical consequences of NCTTL?

A
  • Change in appearance
  • Pain/sensitivity
  • Loss of OVD – occlusal, vertical, dimensional and/or lack of occlusal stability
  • Functional difficulties
39
Q

What is initial management of tooth wear?

A
  • Identify presence and severity of tooth wear
  • Identify aetiology
  • Monitoring
  • Prevention
  • Treatment
40
Q

What is aetiology of tooth wear?

A 
•Take patient history:
o	Food/drink/meds  Take a diet sheet
o	Medical history 
o	Habits 
•Clinical appearance 
•Ongoing aetiological factors may cause
o	Damage to restorations
o	Further wear of teeth
41
Q

How can we monitor tooth wear?

A
  • Study models
  • Silicone index
  • Clinical photographs
  • Description (indices)
  • Measurement
42
Q

how do we measure tooth wear ?

A

o Crown height

o Gingival margin

43
Q

How do we manage NCTTL?

A
  1. Identify the cause
  2. Institute preventative measure and try control TSL (Tooth surface loss)
  3. Monitor the TSL
  4. Operative treatment if required
  5. review
44
Q

What is prevention for erosion ?

A
  • Diet advice
  • Avoid brushing after acidic foods
  • Control of eating disorders (may have to liase with GMP)
  • Water & sodium bicarbonate
45
Q

What are desensitisation and protection products?

A
  • Fluoride Mouthrinses & varnish
  • Fluoride paste –GelKam
  • Low abrasive toothpaste
  • Sugar free chewing gum
  • Dentine bonding agents
  • Anti-erosion toothpaste
  • Tooth mousse
46
Q

How to prevent attrition ?

A
  • Make patient aware/educate
  • Make a splint
  • Restore with composite
47
Q

What do soft or hard splints prevent?

A

tooth wear

48
Q

What does a hard splint do ?

A
  • Provides ideal occlusion/ guidance

* Relaxes muscles & repositions mandible

49
Q

How to prevent abrasion ?

A 
education/habits
o	OHI
o	Bristle stiffness
o	Brushing forces
o	Frequency 
o	Paste abrasivity
50
Q

When to intervene and what to do?

A
  • Intervene early
  • Protect the pulp
  • Improve aesthetics
  • Restore functionality problems
  • Improve loss of structural integrity
  • Prevention of further complex treatment
  • Respect patients wished/co operation

CSA clinical aspects (13 decks)

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