CSA tooth wear Flashcards
What is tooth wear aka?
non carious tooth loss
Is tooth tissue loss normal ?
yes
what is tooth wear?
is pathological when rate of loss is excessive
What problems can it lead to?
aesthetics function or sensitivity
What is tooth wear caused by >
EROSION
ABRASION
ATTRITION
What is erosion?
- irreversible, progressive loss of dental hard tissue by acidic chemical process not involving bacteria
What is abrasion ?
abnormal wearing of tooth substance or a restoration by mechanical process other than tooth contact
Abrasive agents in toothpaste causes abrasion while tooth brushing
what is attrition ?
loss of tooth substance or restoration caused by tooth to tooth contact
Why does erosion increase in young in UK?
acid rich diet
What can tooth wear expose on tooth surface?
dentine
What can erosion be?
extrinsic (external) or intrinsic (from patient)
What are multifactors of erosion
TIME
EXTRINSIC
HOST
TOOTH
What are host factors?
saliva
anatomy
reflex
medical
what are extrinsic factors?
diet
lifestyle
meds
enviro
What are intrinsic acid factors (regurgitation erosion)
- Gastro-oesophageal reflux (GOR)
- Vomiting
- Ruminant eating
What is Gastro-oesophageal reflex?
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
What are GOR symptoms ?
- Heartburn
- Retrosternal discomfort
- Epigastric pain
- Dysphagia
- Chronic cough
- Sore throat
- Hoarseness
- Sour taste at the back of the throat
What are eating disorders?
anorexia
bulimia
what oral hygiene products can be acidic?
o Mouth washes
o Saliva substitutions
What medications can be acidic diet sources?
o Vitamin C
o Asthma inhalers
o Hydrochloric acid this is rare
o Those affecting saliva quality/quantity
What factors involved in dietary erosion?
o amount of substance ingested
o frequency of consumption
o method of consumption through a straw
o timing of consumption
What are predisposing factors to tooth wear?
• Saliva o Flow rate is low o Buffering capacity is impaired o Presence of salivary mucins o Clearance rates from diff oral sites
What is the clinical presentation of erosion at anterior teeth?
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
What is the clinical presentation of erosion at posterior teeth?
o Loss of surface anatomy o Cuspal cupping o “proud restorations” o Darkening of colour o Pulpal exposure rare in permanent teeth
How is erosion different from caries?
In erosion, leads to demineralisation and loss of organic matrix but no loss of matrix in caries
What is attrition?
enamel and dentine wear away at same rate
What forms during attrition ?
secondary dentine
What can attrition lead to?
- possible masseteric hypertrophy > pain in muscles of mastication
- risk of tooth mobility
What is bruxism ?
common in response to stress
• Associated tongue scalloping and/or cheek ridging in active cases
• Masseteric hypertrophy in severe cases
What are factors in tooth abrasion ?
o Tooth brushing o Abrasive dentifrices smokers toothpaste that used to remove stain o Abrasive food particles o Piercings o Habits
What are clinical presentation in mouth of abrasion?
o Mainly cervical
o Sharply defined margins
o Smooth hard surface
o More rounded & shallow if associated with erosion
What is a non carious cervical lesion?
- saucer shaped or groove wedge shaped lesions
• Increasingly elderly dentate population
What is abfraction?
• Occlusal forces cause compressive and tensile stresses, concentrated at cervical region of tooth
What does abfraction cause>
micro fracture of cervical enamel rods
- defects maybe seen sub gingivally
- deep V shape notch seen
What is retention of composite like in cervical lesions?
poor
how to check severity of tooth wear?
- Is it causing any symptoms? / sensitive?
- Is it affecting enamel/dentine/pulp
- Loss of crown height
- Structural integrity compromised?
- Aesthetic concern?
Difficulties from severely worn teeth ?
Lack of tooth tissue pulpal problems aesthetic compromise lack of space for restor. occlusal changes soft tissue change aetiological factors
What are the clinical consequences of NCTTL?
- Change in appearance
- Pain/sensitivity
- Loss of OVD – occlusal, vertical, dimensional and/or lack of occlusal stability
- Functional difficulties
What is initial management of tooth wear?
- Identify presence and severity of tooth wear
- Identify aetiology
- Monitoring
- Prevention
- Treatment
What is aetiology of tooth wear?
•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
How can we monitor tooth wear?
- Study models
- Silicone index
- Clinical photographs
- Description (indices)
- Measurement
how do we measure tooth wear ?
o Crown height
o Gingival margin
How do we manage NCTTL?
- Identify the cause
- Institute preventative measure and try control TSL (Tooth surface loss)
- Monitor the TSL
- Operative treatment if required
- review
What is prevention for erosion ?
- Diet advice
- Avoid brushing after acidic foods
- Control of eating disorders (may have to liase with GMP)
- Water & sodium bicarbonate
What are desensitisation and protection products?
- Fluoride Mouthrinses & varnish
- Fluoride paste –GelKam
- Low abrasive toothpaste
- Sugar free chewing gum
- Dentine bonding agents
- Anti-erosion toothpaste
- Tooth mousse
How to prevent attrition ?
- Make patient aware/educate
- Make a splint
- Restore with composite
What do soft or hard splints prevent?
tooth wear
What does a hard splint do ?
- Provides ideal occlusion/ guidance
* Relaxes muscles & repositions mandible
How to prevent abrasion ?
education/habits o OHI o Bristle stiffness o Brushing forces o Frequency o Paste abrasivity
When to intervene and what to do?
- 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
