Rest: Toothwear Flashcards
TOOTHWEAR
What are two other types of NCTSL ?
Trauma.
Developmental conditions.
TOOTHWEAR
What are the four types of toothwear ?
Attrition, abrasion, erosion, abfraction.
TOOTHWEAR
Define attrition.
Pathological tooth surface loss due to tooth to tooth contact.
TOOTHWEAR
Define erosion.
Pathological tooth surface loss due to chemical process that does not relate to bacteria i.e. chronic exposure to acidic substances.
TOOTHWEAR
Define abrasion.
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.
TOOTHWEAR
Define abfraction.
Pathological, multifactorial tooth surface loss due to repeated biomechnical loading from eccentric forces, leading to compressive and tensile stresses at cervical fulcrum.
TOOTHWEAR
What are some signs/symptoms of attritive toothwear ?
And what is the most likely cause ?
- 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.
TOOTHWEAR
What are some signs/symptoms of abrasive toothwear ?
And what is the most likely cause ?
- Localised toothwear.
- Toothbrushing - cervical lesions on canines & premolars.
- Pipe - V shaped or rounded insical lesions.
- Sharp enamel edges as dentine is worn preferentially.
TOOTHWEAR
What are some signs/symptoms of erosive toothwear ?
What are the possible causes ?
- 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.
TOOTHWEAR
What are the most common presenting complaints patients have with toothwear ?
- Aesthetics.
- Functional ability - mastication.
- Sensitivity.
- Pain - exposure of pulp.
- Sharp edges.
TOOTHWEAR
What is the classification system of NCTSL ? Explain it.
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>
TOOTHWEAR
What special tests might you want for a patient with toothwear ?
Radiographs, intra-oral photographs, articulated study models, diagnostic wax up, sensibility tests.
TOOTHWEAR
The first step of treating toothwear patients is diagnosis. What should be included in your toothwear diagnosis ?
- BEWE score.
- Causative factor.
- Localised or generalised.
- If generalised - is their loss of OVD ? Do you have space ?
- Is there dentoalveolar compensation ?
TOOTHWEAR
Describe dentoalveolar compensation.
Continued eruption/growth of the alveolus and teeth in an attempt to maintain ‘normal occlusion’ for function.
TOOTHWEAR - INITIAL TREATMENT
How can you manage a patient with abrasive toothwear ?
- Restore defects with composite or RMGI.
- Change habits.
TOOTHWEAR - INITIAL TREATMENT
What is the gold standard material used for restoring abrasive defects ?
- 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.
TOOTHWEAR - INITIAL TREATMENT
How should a patient with attritive toothwear be managed initially ?
- Manage parafunctional habits.
- CBT and hynosis for stressor control.
- Splints (soft or hard, Michigan commonly used).
TOOTHWEAR - INITIAL TREATMENT
ATTRITION - what is the benefits of a Michigan splint ?
- Protective - wear in preference to tooth surface.
- Ideal occlusion - centric stops.
- Canine rise - disocclusion on eccentric movements.
TOOTHWEAR - INITIAL TREATMENT
How should a patient be managed with erosive toothwear ?
- Dietary analysis.
- Medication - omeprazole (GORD, hiatus hernia, reflux), xerostomia.
- Liase with GP - anorexia, bullimia (or signposting).
- Increase fluoride exposure - helps with sensitivity too.
TOOTHWEAR - ACTIVE MANAGEMENT
What factors will influence the restorative treatment you can provide ?
- Aesthetic expectations of the patient.
- Space available.
- Space required.
- Pattern of NCTSL.
- Remaining tissue for bonding/overdenture etc.
TOOTHWEAR - ACTIVE MANAGEMENT
What are the five treatment options for restoring anterior tooth surface loss with no interocclusal space ?
- 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.
TOOTHWEAR - ACTIVE MANAGEMENT
Explain the Dahl technique.
- 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.
TOOTHWEAR - ACTIVE MANAGEMENT
What is the advantages of the Dahl technique ?
- Aesthetics.
- Compliance.
- Adjustment.
- Immediate treatment (can be defintive).
- Conservative approach.
TOOTHWEAR - ACTIVE MANAGEMENT
What is the disadvantages of Dahl technique ?
- Rate of eruption is variable.
- No movement within 6 months - not going to work.
- Progress has to be monitored.
- Occlusion disorganised and then stabilises.
