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BDS4 CDS Restorative, Pros & Endo > Rest: Toothwear > Flashcards

Rest: Toothwear Flashcards

1
Q

TOOTHWEAR

What are two other types of NCTSL ?

A

Trauma.
Developmental conditions.

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2
Q

TOOTHWEAR

What are the four types of toothwear ?

A

Attrition, abrasion, erosion, abfraction.

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3
Q

TOOTHWEAR

Define attrition.

A

Pathological tooth surface loss due to tooth to tooth contact.

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4
Q

TOOTHWEAR

Define erosion.

A

Pathological tooth surface loss due to chemical process that does not relate to bacteria i.e. chronic exposure to acidic substances.

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5
Q

TOOTHWEAR

Define abrasion.

A

Pathological tooth surface loss due to repeated abnormal mechanical process independent of occlusion, this can be foreign object or substance i.e. toothbrush, pipe, tongue stud.

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6
Q

TOOTHWEAR

Define abfraction.

A

Pathological, multifactorial tooth surface loss due to repeated biomechnical loading from eccentric forces, leading to compressive and tensile stresses at cervical fulcrum.

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7
Q

TOOTHWEAR

What are some signs/symptoms of attritive toothwear ?
And what is the most likely cause ?

A
  • Smooth, polished wear facets on cusps of molars.
  • Flattening of incisal edges.
  • Reduction in crown/cusp height.
  • Loss of occlusal inclined planes.
  • Restorations will show same wear as tooth substance.
  • Most likely cause - parafunctional habits.
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8
Q

TOOTHWEAR

What are some signs/symptoms of abrasive toothwear ?
And what is the most likely cause ?

A
  • Localised toothwear.
  • Toothbrushing - cervical lesions on canines & premolars.
  • Pipe - V shaped or rounded insical lesions.
  • Sharp enamel edges as dentine is worn preferentially.
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9
Q

TOOTHWEAR

What are some signs/symptoms of erosive toothwear ?
What are the possible causes ?

A
  • More common on maxilla vs. mandible (saliva).
  • Palatal and incisal surfaces (rarely labial).
  • Thinning of enamel at incisal edges.
  • Chalky lesions on palatal surface of teeth.
  • Cupping of occlusal and palatal surfaces as dentine is worn preferentially.
  • Loss of anatomical detail on palatal surfaces.
  • Restorations sit high.
  • Base of lesion not in contact with the occluding contact.
  • No staining in the mouth.
  • Causes - vomitting, reguritation, reflux, dietary habits.
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10
Q

TOOTHWEAR

What are the most common presenting complaints patients have with toothwear ?

A
  • Aesthetics.
  • Functional ability - mastication.
  • Sensitivity.
  • Pain - exposure of pulp.
  • Sharp edges.
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11
Q

TOOTHWEAR

What is the classification system of NCTSL ? Explain it.

A

BEWE scoring system.

0 - no tooth surface loss.
1 - initial tooth surface loss.
2 - distinct tooth surface loss, <50% of hard tissue.
3 - distinct tooth surface loss, >50% of hard tissue.

No risk - <2.
Low risk - 3-8
Medium risk - 9-13
High risk - 14>

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12
Q

TOOTHWEAR

What special tests might you want for a patient with toothwear ?

A

Radiographs, intra-oral photographs, articulated study models, diagnostic wax up, sensibility tests.

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13
Q

TOOTHWEAR

The first step of treating toothwear patients is diagnosis. What should be included in your toothwear diagnosis ?

A
  • BEWE score.
  • Causative factor.
  • Localised or generalised.
  • If generalised - is their loss of OVD ? Do you have space ?
  • Is there dentoalveolar compensation ?
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14
Q

TOOTHWEAR

Describe dentoalveolar compensation.

A

Continued eruption/growth of the alveolus and teeth in an attempt to maintain ‘normal occlusion’ for function.

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15
Q

TOOTHWEAR - INITIAL TREATMENT

How can you manage a patient with abrasive toothwear ?

A
  • Restore defects with composite or RMGI.
  • Change habits.
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16
Q

TOOTHWEAR - INITIAL TREATMENT

What is the gold standard material used for restoring abrasive defects ?

A
  • RMGI - lower modulus and most similar flexural strength to dentine, best survival rate.
  • Can use composite - risk of secondary caries, staining, higher modulus, less flexural strength and therefore, more likely to fail.
17
Q

TOOTHWEAR - INITIAL TREATMENT

How should a patient with attritive toothwear be managed initially ?

A
  • Manage parafunctional habits.
  • CBT and hynosis for stressor control.
  • Splints (soft or hard, Michigan commonly used).
18
Q

TOOTHWEAR - INITIAL TREATMENT

ATTRITION - what is the benefits of a Michigan splint ?

A
  • Protective - wear in preference to tooth surface.
  • Ideal occlusion - centric stops.
  • Canine rise - disocclusion on eccentric movements.
19
Q

TOOTHWEAR - INITIAL TREATMENT

How should a patient be managed with erosive toothwear ?

A
  • Dietary analysis.
  • Medication - omeprazole (GORD, hiatus hernia, reflux), xerostomia.
  • Liase with GP - anorexia, bullimia (or signposting).
  • Increase fluoride exposure - helps with sensitivity too.
20
Q

TOOTHWEAR - ACTIVE MANAGEMENT

What factors will influence the restorative treatment you can provide ?

A
  • Aesthetic expectations of the patient.
  • Space available.
  • Space required.
  • Pattern of NCTSL.
  • Remaining tissue for bonding/overdenture etc.
21
Q

TOOTHWEAR - ACTIVE MANAGEMENT

What are the five treatment options for restoring anterior tooth surface loss with no interocclusal space ?

A
  • Dahl technique.
  • Conventional orthodontic treatment.
  • Indirect fixed prosthodontics (+/- surgical crown lengthening).
  • Selective RCT and post-crowns.
  • Occlusal reorganisation from ICP to RCP by increasing OVD.
22
Q

TOOTHWEAR - ACTIVE MANAGEMENT

Explain the Dahl technique.

A
  • Provide upper removable appliance with anterior bite plane (2-3mm).
  • Or restore anterior teeth with composite to increase OVD by 2-3mm.
  • Disoccludes posterior teeth to allow for passive eruption and intrudes uppers.
  • Over period of 3-6 months, teeth will erupt into disorganised occlusion which will stabilise.
  • This treatment works best in younger patients.
23
Q

TOOTHWEAR - ACTIVE MANAGEMENT

What is the advantages of the Dahl technique ?

A
  • Aesthetics.
  • Compliance.
  • Adjustment.
  • Immediate treatment (can be defintive).
  • Conservative approach.
24
Q

TOOTHWEAR - ACTIVE MANAGEMENT

What is the disadvantages of Dahl technique ?

A
  • Rate of eruption is variable.
  • No movement within 6 months - not going to work.
  • Progress has to be monitored.
  • Occlusion disorganised and then stabilises.
25
Q

TOOTHWEAR - ACTIVE MANAGEMENT

What are the contraindications for using the Dahl technique ?

A
  • Patients taking bisphosphonates.
  • Active periodontal disease.
  • TMD.
  • Post-orthodontic treatment.
  • Implants.
  • Conventional bridge work.
26
Q

TOOTHWEAR - OVERDENTURES

Explain what an overdenture is ?

A

Removable prosthesis which sits over one or more natural teeth, roots or implants.

27
Q

TOOTHWEAR - OVERDENTURES

What are the advantages of overdentures ?

A
  • Transition to edentulism.
  • Proprioception.
  • Preservation of alveolar ridge.
  • Avoids extractions - MRONJ, ORN, elderly patients.
  • Can stabilise occlusion.
  • Good aesthetics.
  • Support - tooth and mucosa borne.
  • Toothwear management - when 2/3 of tooth height loss.
  • Improves denture retention (+/- precision attachments).
28
Q

TOOTHWEAR - OVERDENTURES

What are the disadvantages of overdentures ?

A
  • Requires optimal OH.
  • Higher caries risk or periodontal disease risk.
  • Risk of infection of retained roots.
  • Potential for future traumatic XLAs.
  • Discomfort.
29
Q

TOOTHWEAR - OVERDENTURES

What care should be provided for patients with overdentures ?

A
  • Topical fluoride application on root surfaces.
  • Good OH.
  • Regular examinations and radiographs - looking for signs of infection.
  • Denture hygiene advice.
30
Q

TOOTHWEAR - OVERDENTURES

What are the three types of overdentures ?

A

Transitional, metal based, simplifying small saddles.

31
Q

TOOTHWEAR - BREAKING BAD NEWS

What is the acronym used for breaking bad news ?

A

SPIKES

32
Q

TOOTHWEAR - BREAKING BAD NEWS

Explain the acronym SPIKES.

A
  • Set up the interview - physically and mentally.
  • Perception - understand what patient already knows.
  • Invitation - how much do they want to know ?
  • Knowledge - give medical facts.
  • Emotions - acknowledge and respond to patient’s emotions.
  • Strategy/summary - negotitate concrete follow up.

BDS4 CDS Restorative, Pros & Endo (13 decks)

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