tooth wear 1 Flashcards
What is the range of loss for physiological tooth loss?
20-35 micromillimetres per year
Define pathological tooth wear
If the remaining tooth structure or pulpal health is compromised
If the rate of tooth loss is excessive for the age
If the patient experiences a masticatory or aesthetic deficit
What is attrition and where is it found?
The physiological wearing away of tooth structure as a result of tooth to tooth contact
Almost always related to a parafunctional habit
Found on occlusal and incisal contacting surfaces
What is abrasion?
The physical wear of tooth substance through an abnormal mechanical process independent of occlusion
Involves a foreign object or substance repeatedly contacting the tooth
Usually V shaped or rounded lesions
Where is abrasion commonly found?
Labial/buccal, cervical on canines and premolars
What are the causes of abrasion?
Aggressive tooth brushing technique
Electric wire stripping
Pipe smoking
Smoking e-cigarettes
What is erosion?
The loss of tooth surface by a chemical process that does not involve bacterial action, most common cause of pathological toothwear
What causes erosion?
Chronic exposure of dental hard tissues to acidic substances
What is the difference between early and late erosion?
Early - enamel surface affected, loss of surface detail
Later - dentine becomes exposed, leads to cupping of occlusal surfaces or molars and incisal edges of anterior teeth
What types of toothwear does not affect restorations?
Erosion
What is abfraction?
The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
V shaped tooth loss where the tooth is under tension
What are the two theories of abfraction?
- Abfraction is the basic cause of all non-carious cervical lesions (not likely)
- Multi factorial aetiology - a combination of occlusal stress, abrasion and erosion
How does the prevalence of tooth wear differ between males and females?
Male - 60%
Females - 70%
Name 4 medical history components related to toothwear
Any from:
- meds with low pH
- meds which cause dry mouth
- eating disorders
- alcoholism
- heartburn
- GORD
- hiatus hernia
- rumination
- pregnancy (morning sickness)
Which components of dental history relate to toothwear?
Poor OH habits
Tooth brushing in abrasive wear - frequency, intensity, duration and type of toothpaste
Name 4 components of social history that relate to toothwear?
Any from:
- stresses (bruxism)
- occupation
- alcohol consumption
- dietary analysis
- habits
- sports
Name 4 components of an extra-oral exam that are important when looking at toothwear
Any from:
- TMJ exam for restriction of movement, clicking or crepitus (shown in attritive wear)
- muscular hypertrophy
- limited mouth opening and deviation during opening
- lip line
- smile line
Which components of an intra-oral exam are important when looking at toothwear?
Overclosure
Soft tissues - dry, buccal keratosis or lingual scalloping
Oral hygiene
BPE
Charting
How should the occlusion be assessed when examining toothwear?
Assess freeway space
Record OVD and resting face height
Is there any dento-alveolar compensation
Record OB and OJ
Are there stable contacts in ICP
What are teeth contacts like in excursive movements
How should tooth wear be examined?
By location - anterior/posterior, localised/generalised
By severity - enamel only, into dentine, severe
Describe BEWE (basic erosive wear examination)
Used as a diagnostic tool
Score each sextant of the mouth between 0 and 3, add up the scores for a total score
What does each score mean in BEWE (basic erosive wear examination)
0 - no erosive wear
1 - initial loss of surface texture
2 - distinct defect, hard tissue loss <50% of surface
3 - hard tissue loss >50% of the surface area
Name 4 special tests that can be used for toothwear
Any from:
- sensibility testing
- radiographs
- articulated study models
- intra-oral photography
- diagnostic wax-up
- dietary analysis
