Tooth wear 1 Flashcards
What is tooth surface loss?
This is any loss of tooth tissue and can be:
caries
trauma
developmental problems
tooth wear
What are 4 examples of tooth surface loss?
Caries
Trauma
Developmental problems
Tooth wear
What is non carious tooth surface loss?
This is loss of dental tissue as a result of trauma, developmental problems and tooth wear
What are the two types of tooth wear?
Normal physiological tooth wear
Pathological tooth wear
What is normal physiological tooth wear?
This is tooth wear that is normal and increases with age - normal wear associated with normal function (as we age teeth will inevitably wear at around 20-38 microns)
What is pathological tooth wear?
This is where there is excess tooth wear from what we would expect for pt at that age
pt may have fictional or aesthetic problems associated with pathological tooth wear
What may pts experience with pathological tooth wear?
Aesthetic problems
Functional issues
What are the types of pathological toothier? 4
Erosion
Attrition
Abrasion
Abfraction
What Is cervical wear a combination of?
multifactorial - combo of brushing too hard
Where is cervicle wear most common to be seen?
Premolars and molars on buccal surface (not usually seen lingually)
more common on upper jaw
What do pts with cervicle lesions often have?
Good OH and brush excessively (often 4x day)
Cervicle abrasion restorations wear at the same rate as what?
Tooth structure - its a process caused by pt by excess brushing or excess force when brushing (often abrasion but also erosion, abfraction also)
What is attrition?
Tooth wear caused by tooth to tooth contact - there is physiological wear of tooth structures due to tooth contact
Where is attrition common?
Incisal edge and occlusal surfaces of teeth
How does attrition initially look?
Polished, smooth facet on cusp of slight flattened incisal edge
What does progressive attrition look like?
Reduction in cusp heigh
flattened occlusal planes
teeth are shorter looking as clinical crown has been worn down
flat facets, teeth join to each other (no canine cusp tip)
Does rate of tooth wear in attrition occur at same rate in teeth and restorations?
Yes attrition will happen at same rate in teeth and restorations - teeth will become flat
What is abrasion?
This is physiological tooth wear cased by non dental objects such as a toothbrush which is repeatedly contacting the tooth
it is an abnormal mechanical process
Where does abrasion lesion usually found?
Depends on pattern of abrasive element - often seen labially/buccaly esp cervicle on the canine and premolar teeth
What shape are abrasion lesions?
V shaped
Round shaped
What is most common cause of abrasion lesions?
toothbrushing is most common
can also be caused by holding pipe, smoking e cig, thread holding - depending on occupation)
Where do abrasion lesions progress quicker?
On root surface
What is erosion?
This is physiological tooth wear which is caused by a chemical process resulting in tooth loss
(often caused by acid) - such as fizzy drinks, stomach acid
What are some intrinsic acids?
Acid reflux
GORD
Wha are some extrinsic acids?
Fruit
Fizzy Juice
What is the position and severity of erosion dependent on?
Sourcem type, freq of acid exposure
What does erosion do to teeth?
Makes incisal edges more translucent - pt may complain of darker edges due to shin through of mouth as teeth thin
What is different between erosive and attractive wear?
When the teeth tough toughener the deepest part of the wear is not teaching between the teeth - enamel is still present and deepest area of wear Is dentine and dentine is softer and is destroyed quicker - often see a ring of enamel and preferential wear of dentine
Do we see staining in erosion cases?
No - acid tends to wash stains away
What do we see in anorexia and bulimia?
palatal wear
What is abfraction?
This is where we have loss of hard tissue due to exocentric occlusal forces leading to compressive and tensile stresses at cervicle area of tooth leading to lesions
PATHOLOGICAL LOSS OF TOOTH TISSUE AT CERVICLE MARGIN
not all clinicians believe in it
theories:
- mltifactorial
- abfraction is basic cause of all non carious cervicle lesions
What shape is abfraction lesions?
V shaped
What is cause of tooth wear?
Age = normal psychological process
Pathological:
- parafunctional habits. - bruxism, clenching
stress
How do we assess tooth wear?
assess if pt has tooth wear
dx type of tooth wear - attrition, erosion, abrasion
dx likely cause or cause (we may never know if pt isn’t helping us)
extent of tooth wear
is disease active or history (pt may have had stress period 5 years ago which is now over and tooth wear has returned to normal process which no longer progressed or is it active and pt is currently undergoing pathological wear)
What are the tx for tooth wear cases?
PREVENTION
ACTIVE RESTORATIVE TX (no unless case is determined and stopped)
What are pts main concerns in tooth wear cases?
Aesthetics rather than function
What is pts main aesthetic concern in tooth wear cases?
Short teeth
teeth dont show when im smiling
What function problems may pts with tooth wear have?
problem eating, biting tongue or lips
sensitivity ?
What function problems may pts with tooth wear have?
problem eating, biting tongue or lips
sensitivity ?Wh
Why is pain unlikely in tooth wear cases?
Tooth wear usually occurs slowly over years resulting in deposition of secondary dentine which protects the pulp but if tooth wear occurs rapidly then yeah we can get pain and pulp involement
Why is MH important in tooth wear cases?
Does pt have GORD
Acid reflux?
Medications - low pH which are causing erosive wear
Medications - xerostomia
ED - bulimia (erosion)
Alcoholism (acidic nature except gin!)
Hiatus hernia
Rumination - chewing, brining food up then re swallow
pregnancy - transient erosive problem due to morning sickness, heartburn and reflux)
If we suspect tooth wear is due to GORD what can we do?
Consider referral to GP - pt may need tx
