Restorative Dentistry Flashcards
what is the definition of attrition
act of wearing or grinding down by friction - mechanical wear resulting from mastication or parafunction
name three features of attrition
lesions on occlusal and incisal contacting surfaces
polished facet on a cups
slight flattening of an incisal edge
what is the definition of abrasion
physical wear of tooth substance through an abnormal mechanical process independent from occlusion
- involved foreign object or substance repeatedly contacting tooth (eg toothbrushing)
name three features of abrasion
labial/ buccal areas
V-shaped or rounded lesions
sharp margin at enamel edge
what is the definition of erosion
progressive loss of tooth substance by chemical processes that do not involve bacterial action
name three features of erosion
bilateral concave lesions
translucent incisal edges
cupping of occlusal surfaces
is inner enamel or outer enamel more susceptible to acid attack
inner enamel
what is the definition of abfraction
loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at cervical fulcrum
name three features of abfraction
cracks in tooth substance
sharp rim at amelo-cemental junction
V-shaped tooth loss
name seven risk factors for erosive tooth wear
GORD
alcoholism
vomiting
heartburn
eating disorders
iron
hiatus hernia
what is intrinsic erosion
occurs with vomiting
patients are sick and then freshen up with water
which three mechanisms prevent reflux during swallowing
elevation of soft palate
tongue contacting pillars of fauces
upper and lower oesophageal sphincters
what is extrinsic erosion
can be due to medications and oral hygiene products
name examples of medications that can cause extrinsic erosion
Vit C tablets - chewable ones
Iron preparations that are acidic and commonly taken during pregnancy
Mouthwash and artificial saliva products that are acidic
why is the enamel around gingival margin less affected in erosion
due to the buffering affects of gingival crevicular fluid
GCF has pH of 7.5-8.7
name five aspects of a patient’s social history that may cause erosive tooth wear
occupation - wine tasters
hobbies and sport
alcohol intake
recreational drugs - ecstasy (reduces saliva)
psychological stress
what questions should you ask a patient about their drinking habits on their diet sheet
sipping drinks
swishing drinks
frothing drinks
if they hold drinks in their mouth before swallowing
what type of acid is the worst for acid erosion
citric
what aspects of extra-oral examination are important to a toothwear patient
TMJ and MOM
tenderness and hypertrophy
shortening of teeth and poor dental aesthetics
overclosure
what aspects of intra-oral examination are particularly for a tooth wear patient
soft tissues and charting
incisor relationship and dynamic occlusion
canine guidance vs group function
extent of tooth wear
what are the indices for describing tooth wear
The Tooth Wear Index - Smith and Knight
BEWE - basic erosive wear examination
what are the scores for the Tooth Wear Index by Smith and Knight
0 - no loss of enamel surface characteristics or change of contour
1 - loss of enamel surface characteristic and minimal change in contour
2 - enamel loss exposing just exposing dentine and defect less than 1mm deep
3 - enamel loss and dentine loss but no pulp exposure and defect is 1-2mm deep
4 - complete enamel loss/ pulp exposure and defect is more than 2mm deep
how is the Tooth Wear Index by Smith and Knight carried out
each surface of the tooth is given a score between 0 and 4 according to the appearance (B, L, O, I, C)
what are the scores for the BEWE examination
0 - no erosive tooth wear
1 - initial loss of surface texture
2 - distinct defect with hard tissue loss that is less than 50% of the surface area
3 - hard tissue loss more than 50% of the surface area
how is the BEWE examination carried out
by sextant - highest score applies to the sextant
name the treatment options for tooth wear
manage sensitivity
diet diary and advice
GMP to optimise reflux management
splint, monitor, review
composite additions
indirect restorations
name two ways you can help a patient who will not give up acidic drinks
having fruit drink as part of a meal as saliva flow is highest at meal times
drink with a straw
name three appropriate treatment options to monitor sensitivity
3 day diet analysis
make casts - monitor if prevention is working
treat with fluoride varnish or dentine bond
what is the treatment options for a score of 0/1 on the BEWE assessment
check space in ICP and RCP
restore in direct composites (around 1mm thickness) if space present
no space present = Dhal approach
splint therapy
review in 6 months
name treatment options for BEWE scores of 2 (moderate/ general tooth wear)
restore worn surfaces
increase OBD if required
ensure canine guidance/ group function and even contact in ICP
splint
monitor
consider full coverage restorations
with regards to tooth wear patients - what should be referred for specialist treatment
repeated failure of restorations
BEWE score of 3
the initial steps for treating patients with tooth wear in general practice are eliminate sources of wear and preventative programme - how would you eliminate sources of wear
diet diary
address parafunction
habits - pencil chewing/ nail biting
toothbrushing technique
lifestyle habits - stress and recreational drugs
the initial steps for treating patients with tooth wear in general practice are eliminate sources of wear and preventative programme - what 4 aspects are part of the preventative programme
high fluoride toothpaste/ mouthrinse
lifestyle changes and diet advice
occlusal splint therapy
study models for monitoring/ clinical photos
what should referral of tooth wear for specialist advice include
accurate study models
photographs
radiographs
what desensitising solution can you use for sensitivity due to tooth wear
5% glutaraldehyde
name two contra indications of anterior composite build ups
short roots
reduced periodontal support due to periodontal disease
what type of composite is better for composite build ups
hybrid composites are better than microfill
what are the stages when undertaking a composite build up case
take alginate impressions
wax up on study models
make putty matrix of diagnostic wax up
what should be included on the lab sheet when undertaking composite build ups that will change the OVD
please pour upper and lower study models as per jaw registration using face bow mounting
please increase OVD by 2-3mm and wax up teeth XXX to create normal form
please create canine guidance in R and L lateral excursions
what can be used to aid as a mould for composite build ups
clear vacuum formed clear plastic matrix
formed from the study model
explain anterior composite build ups as if you were discussing with a patient
your front teeth will receive tooth coloured fillings to cover the exposed and worn surface
this prevents the teeth from wearing more
this is carried out with LA and has minimal or no drilling to your teeth
we add to the tooth - and do not remove any tooth structure
what 7 instructions/ warnings should the patient follow after having anterior composite build ups that have changed the OVD
your bite will feel strange for a few days
you may have difficulty chewing
only your front teeth will touch together
your back teeth will gradually come back together but this will take 3-6 months
the change of shape of your front teeth may cause lisping for a few days
you may bite your tongue and lips initially
if you have crowns/ bridges or partial dentures at the back of your mouth it is likely they will need replaced
