ILA Flashcards
What are potential intrinsic forms of erosive toothwear and what can they be triggered by?
GORD: Can be triggered directly by gastric reflux or side effect of medications
How can dentists test the progression of erosive tooth wear?
Scratch test using an explorer
Why is citric acid particularly dangerous for tooth wear?
Lemons pH 2 (Citric Acid): highly damaging due to both direct acid attack and chelation.
Chelation works when the acidic anion (citrate) works to sequester calcium away from both the tooth and the saliva. This prevents remineralisation.
What tooth wear patterns are evident for intrinsic acid sources?
Wear of palatal as well as occlusal surfaces
Why might dentinal hypersensitivity occur with erosive tooth wear?
Acidic dissolution of smear layer leaves dentinal tubules open and exposed.
How would severe tooth wear on both arches manifest for a patient’s occlusion?
- Changed intercuspal position
- Intercuspal Position no longer in concert with Centric Relation
- Shortened facial profile - making the chin closer to the nose
- Side profile - will appear more convex in nature
A loss of canine guidance will result in what?
Use of group function by 1-2nd pre-molars
When rebuilding OVD, what are some goals in restoring masticatory and occlusal function
- Stability for muscles of mastication
- Even Distribution of Load whilst in intercuspal occlusion
- Unimpeded Mandibular Movements - posterior disclusion on Lateral Excursion, Incisor-to-Incisor
When would repairing an amalgam be indicated and how would you do the subsequent restoration
If the existing amalgam is sound, and removal puts the tooth at risk
New amalgam
- All corrosion products from old amalgam removed
- Adequate mechanical retention
- Amalgam must be highly compacted and burnished on margins
You have a patient where you wish to re-establish the biofilm subsequent to preventative treatment. What would you prescribe for home use?
Colgate Savacol Original Mouthwash (0.2%) 2mg/mL chlorhexidine gluconate. Use 2x daily for 2 weeks.
You have a 10 year old who has high caries risk with mixed dentition. What fluoride should you be advising them to use?
For both 18mths - 6yrs and 6yrs - teenager groups, moderate and high risk individuals should use:
- Drink Fluoridated Water
- Brush with standard toothpaste 2+ times/day
- Spit no Rinse
You have a high caries risk patient. On completion of the treatment plan, what should the recall frequency be based off Caries Management System?
Every 3 months until:
- Home Care goals hav ebeen achieve (OH and Fluoride)
- Lesion Progression has arrested/reversed
- Reclassification as medium / low risk
You have a medium caries risk patient. On completion of the treatment plan, what should the recall frequency be based off Caries Management System?
Every 6 months after completion of treatment plan
You have a low caries risk patient. On completion of the treatment plan, what should the recall frequency be based off Caries Management System?
Every 12 months after completion of treatment plan
What is a twin block appliance used for?
Growth modification application that can help correct an overbite whilst the jaw is still in development. It is typically worn 24 hours/day.
What are some oral implications of Tricyclic Antidepressants?
Increases the chances of GORD and erosive wear via reflux/regurgitation.
What is the chemistry of direct acid attack on tooth enamel?
Direct attack by the H+ below the critical pH of FA (4.5) and HA (5.5) combine with the CO3 and/or PO4
releasing ions from the crystal surface leading to direct surface etching
What is the pH of intrinsic acids involved with tooth wear?
Hydrochloric Acid = pH 1
What factors modify the severity of acid erosive potential on teeth?
Food pH Total Volume of Acid (Titratable Acid) pKa Calcium Chelation Properties Host Calcium / Phosphate / Fluoride concentration in saliva Adhesion factors
How does calcium chelation work?
Citrate in citric acids sequesters calcium away from the tooth and saliva. Moving it out of a closed ecosystem prevents remineralisation
How does tooth wear affect masticatory function?
Loss of occlusal stability Loss of anterior / canine guidance Progression to Group Function Loss in Cusp Height Change in OVD Muscle tenderness/pain from lack of coordination of muscles of mastication Remodelling of masticatory pattern TMJ remodelling Flattening of Condyle
