Tooth Wear 1 Flashcards
What are some examples of tooth surface loss?
- Everything that can cause it
- Caries
- Trauma
- Developmental problems
- Tooth wear
What are some examples of non-carious tooth surface loss?
- Trauma
- Developmental problems
- Tooth wear
What are the two types of Tooth wear?
- Pathological
- Physiological
What is Physiological tooth wear?
- The normal wear associated with normal function for that individual
What is the Normal estimate of Physiological tooth wear per annum?
- 20-38um per year
What is pathological tooth wear?
- Occurs if the remaining tooth structure or pulpal health is compromised
- The rate of tooth wear is in excess of what is expected for that age
What are the 4 main causes of tooth wear?
- Attrition
- Abrasion
- Erosion
- Abfraction
What is the definition of Attrition?
- The physiological wearing away of tooth structure as a result of tooth to tooth contact
Where are Attritive lesions most commonly found?
- Found on occlusal and incisal contacting surfaces
What is the early appearance of an attritive lesion?
- Polished facet on a cusp
- or a Slight flattening of an incisal edge
What does progression of an attritive lesion cause?
- Lead to reduction in cusp height
- Lead to flattening of occlusal inclined planes
What are some other findings for attritive lesions?
- Shortening of clinical crown of incisor and canine teeth
What is Attrition almost always related to?
- Parafunctional habit ( Bruxism)
- Flat facets are also present and related to functional and often parafunctional movements
When talking about Attrition what occurs to the restorations as well as tooth structure?
- Show the same wear as the tooth structure
What is the definition of Abrasion?
- The physical wear of tooth substance through an abnormal mechanical process independent of occlusion.
- It involves a foreign object or substance repeatedly contacting the tooth.
What is the most common area that is affected by Abrasion?
- Labial/ buccal and cervical on canine and premolar teeth
What do abrasion lesions look like clinically?
- V shaped or rounded lesions
- Have sharp margin at enamel edge where dentine is worn away preferentially
What is the commonest cause of Abrasion?
- Tooth brushing
Abrasion can manifest as notching of incisal edges. What can this be related to?
- Habits/lifestyle/occupation
- Pins, nails, electrical wire stripping, fishing line, thread, pipe smoking
Slide 18 **
What is the definition of Erosion?
- The loss of tooth surface by a chemical process that does not involve bacterial action
What is the most common cause of pathological tooth wear?
- Erosion
- INcreasing in prevalence
What is Erosion caused by?
- Chronic exposure of dental hard tissues to acidic substances
- Acidic substances can be extrinsic or intrinsic
What is the appearance of an erosion lesion?
- Typically bilateral
- Concave lesions
- Do not have chalky appearance of bacterial acid decalcification
What occurs in early stage erosion lesion?
- Enamel surface affected
- Loss of surface detail
- Surfaces become flat and smooth
- Later dentine becomes exposed
What does preferential wear of dentine lead to?
- Leads to ‘cupping’ of occlusal surfaces of molars and incisal edges of anteriors
What are the factors which determine the severity of erosive wear?
- Source
- Type
- Frequency of exposure to acid
In Erosion cases how would amalgam and composite restorations appear?
- Stand proud of tooth
What are some other presentation of erosive wear?
- Increased translucency of incisal edges ( can appear dark)
- Base of lesion not in contact with opposing tooth
- No tooth staining present
What is the definition of Abfraction?
- The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
What are the theories in regard to Abfraction?
- Abfraction if the basic cause of all non-carious cervical lesions
- Multifactorial aetiology. A combination of occlusal stress, abrasion and erosion
Slide 28, 29,30-37
During assessment of a pt what are the stages you must complete?
- Recognise the problem is present
- Grade its’ severity
- Diagnose the likely cause or causes
- Monitor the progression of the disease
- Is it active or historic
- Are preventative measures working or is active restorative treatment required
What Medical History is relevant to tooth wear cases ( particularly erosion cases)?
- Medications with low pH
- Medications which dry the mouth
- Eating Disorders
- Alcoholism
- Heartburn
- GORD
- Hiatus Hernia
- Rumination
- Pregnancy
- Patients are not always aware of reflux
(Pt may require referral to GMP - require consent to do this)
What is the relevant past dental history?
- Regular attender previously (tooth wear require a lot of visits so need good attendance)
- Previous experience of txt (simple, complex)
- OH habits
- Poor OH
- Toothbrushing so ask frequency, Intensity, Duration, type of toothpaste
What is relevant for Social history?
- Lifestyle stresses (Bruxism)
- Occupational details
- Alcohol consumption
- Dietary analysis
- Habits
- Sports
What are some main things you need to look for when examining the pt?
- Extra Oral
- Must examine TMJ for restriction of movement, clicking, crepitus
- Examine musculature for hypertrophy
- Examine mouth opening for restriction (<4cm) and deviation during movement
- ? Parotid hypertrophy
- Overclosure ?
- Lip Line
- Smile line
What is Overclosure?
When examining the occlusion of a pt what are the main things that should be recorded?
- Freeway space
- OVD and resting face height
- If there is any dento-alveolar compensation
- Overbite and overjet
- Are there stable contacts in centric relation
- What are tooth contacts like in excursive movements
What is recorded when performing a Wear examination?
- Location (Anterior/Posterior , Generalised)
- Severity (Enamel only, into dentine, Severe)
What is the most common location of wear?
- Generalised anterior
What is the BEWE wear index ? (More used than Smith and Knight)
0 - No erosive wear
1 - Initial loss of surface texture
2 - Distinct defect, hard tissue loss <50% of surface
3 - Hard tissue >50% of surface area
What are the risk levels for BEWE? (add up all sextants)
None - Less than or equal to 2
Low - Between 3 and 8
Medium - Between 9 and 13
High - 14 and over
What special tests can be used in tooth wear cases?
- Sensibility testing
- Radiographs (useful for sever tooth wear 1/3-1/2 loss of tooth)
- Articulated study models
- Intra-oral photographs
- ? Salivary analysis
- Diagnostic Wax-up
- Dietary analysis
