Tooth Wear Flashcards
Define “tooth surface loss”
the loss of tooth substance as a result of:
- caries
- trauma
- developmental problems
- tooth wear
what are possible causes of non-carious tooth surface loss?
- trauma
- developmental problems
- tooth wear
define “physiological tooth wear”
normal tooth wear associated with normal function of the dentition
define “pathological tooth wear”
- the remaining tooth structure or pulpal health can be compromised
- tooth wear occurring at a rate faster than physiological tooth wear
- wear that can cause the patient to experience a masticatory defecit
What are the 4 subcategories of tooth wear?
- attrition
- erosion
- abfraction
- abrasion
define “attrition”
the physiological wearing away of tooth tissue as a result of tooth to tooth contact
define “abrasion”
the physical wear of tooth substance through an abnormal mechanical process, independent of the occlusion
define “erosion”
the loss of tooth surface by a chemical process that does not involve bacterial action
define “abfraction”
the loss of hard tissue from eccentric occlusal forces, leading to compressive and tensile stresses at the cervical fulcrum of the tooth
On which tooth surfaces are attritive lesions found and why?
the occlusal and incisal surfaces of the teeth
- the wear facets occur where there is tooth to tooth contact
what is almost always the case of attrition?
a parafunctional habit, specifically bruxism
define “bruxism”
the grinding and clenching of teeth outwith normal function
What is an important distinction between erosive wear and attritive wear you can identify on the teeth?
any restorations will wear at the same rate as the tooth tissue in attrition, however erosion will mean that the restorations will sit proud of the eroded tooth surface
what are the most common areas to experience abrasive wear and why?
the labial/buccal cervical region of the crown
- this is because abrasion is usually caused by brushing too hard in these areas
What do abrasive lesions appear like and why?
they form V shaped notches in the tooth tissue with a sharp edge at the enamel as dentine is worn away preferentially (softer)
Apart from toothbrushing, what are other cases of abrasion?
- occupational links (nails in teeth, electrical wire stripping, sewing needles)
- pipe smoking
- dietary habits (chewing seeds and cracking hard foods)
- e cigarettes
- nail biting
what is the most common form of pathological tooth wear?
erosive wear
how does erosive wear appear in the early and late stages?
early = loss of tooth surface detail, smooth and flat tooth surface
late = bilateral concave lesions without the chalky appearance that is a result of bacterial acids. Exposed dentine worn faster than enamel leading to cupping of the tooth surface
Why may the incisal edges appear “dark” in erosive wear of anterior teeth?
the tooth structure is thinner, and therefore more translucent, which causes the darkness of the back of the mouth to be seen through the incisal edges
what are the 2 theories of how abfraction is thought to occur?
- it is the basic cause of all non-carious cervical lesions
- there is a multifactorial aetiology which is a combination of occlusal stress, abrasion and erosion
Describe the mechanics of how abfraction occurs
- biomechanical forces applied to the teeth cause flexure of the enamel at its weakest point
- this is the fulcrum area, at the cervical margin. as the tooth bends, more force it concentrated here
- this causes disruption of the ordered crystalline structure of the enamel and dentine, caused by cyclic fatigue
- the tooth will bend slightly when forced are applied and this will increase as the tooth weakens, causing tissue to wear away and break off
what 4 things must you do when assessing wear cases?
- recognise a problem is present
- grade the severity of the wear
- diagnose the likely cause or causes of the wear
- monitor the progression of the disease over time
what medical issues may be contributing to tooth wear in some patients?
- medications with a low pH
- medications that cause dry mouth
- eating disorders
- alcoholism
- heartburn
- GORD
- hiatus hernia
- rumination
- pregnancy (transient problem - morning sickness, heartburn and reflux)
what features of a persons past dental history are relevant to wear cases and why?
- what their previous attendance was like (regular attendance is key for engagement in often complex treatment of wear cases)
- dental phobia (again patient attendance and commitment)
- patient cooperation is key
- previous experience of treatment (can be quite complex to undergo)
- oral hygiene habits (is toothbrushing contributing to wear, do they have poor OH)
what social history factors are importatnt to assess in wear cases?
- Lifestyle factors- Stressful lifestyle more likely to have parafunctional habits
- Occupational details- Some occupations more prone than others to parafunction and bad habits causing wear- Taxi drivers, electrician, joiners, seamstress
- Alcohol consumption- Straight gin is the only non acidic alcohol
- Dietary analysis
- Habits and hobbies -Weight lifting and grinding
- Sports - Runners gels
What may you find in an E/O exam of a patient who has wear?
- TMJ issues (trismus from muscle spasm, crepitus, pain)
- MoM (hypertrophic and sensetive in parafunctional cases)
- trismus (deviation of the jaw and limited opening <4cm)
- swelling/asymmetry (parotid or muscular hypertrophy)
- overclosure (reduced tooth height)
- low lip and smile line as loss of crown height
What must be assessed in the I/O exam in a patient who exhibits signs of tooth wear?
The Occlusion
- FWS should be assessed
- Record the OVD and RFH (these are often normal as the wear happens really slowly and there is dento-alveolar compensation)
- Has there been dento-alveolar compensation
- Record the overbite and overjet
- Are there stable contacts in centric relation
- what are the tooth contacts like in excursive movement (can you re-establish canine guidance)
Soft tissue
- are they dry
- any signs of buccal keratosis or lingual sculpting
Oral Hygiene
BPE
dental charting
What should you record in regards to the presentation of tooth wear in the mouth?
- location (anterior, posterior, generalised)
- severity (enamel only, into dentine, pulp compromised)
- wear indice score (BEWE)
What do the BEWE scores range from?
0-3