Tooth Wear Flashcards
What is the importance of aetiology in tooth wear
aids clinical diagnosis and treatment planning
reduces further wear
identify wider medical and wellbeing issues
allows you to be realistic with patient - plan for failure
aids consent process
what are factors in rate of attrition
attrition has a spectrum of rates - physiological to bruxist
lack of posterior teeth
occlusion - deep overbite
restorations - porcelain is abrasive
erosion and abrasion combination
stress & anxiety - parafunction
what are common features of a bruxist
significant wear throughout dentition
repeated restoration fracture
root fracture
give examples of extrinsic and intrinsic acids
extrinsic - carbonated drinks, sports drinks, cirtus drinks & fruit, acidic sweets, pickles, alcohol
intrinsic - GORD, bulimia, remunation
what are modifying factors affecting the rate of progression of erosion
amount and frequency
level of control
psychosocial
what common features seen in erosion due to acidic drinks
anterior incisal edge erosion - grey translucent appearance
cupping defects in lower molars
palatal erosion of upper incisors
sensitivity
white spot and brown spot lesions on buccal and interproximal areas
what are common features of an eating disorder
palatal erosion of upper teeth
dentine exposed with enamel halo
polished restorations
erosion around restorations
altered taste and hallitosis
what are some causes of abrasion
tongue stud
toothbrushing
occupational - electrictian, joiner
what are some features to consider with abrasion due to toothbrushing
is it generalised or localised
toothpaste abrasiveness
toothbrushing technique - electric or manual - might be cheap electric with no pressure sensor
give tailored OHI
frequency and duration
might be part of combination or anxiety/OCD
how can an alcoholic present with tooth wear
erosion due to alcoholic drinks - highly acidic
being sick the next day - intrinsic erosion
abrasion - trying to improve condition by over brushing to make mouth feel cleaner
high stress and anxiety - bruxist
how can you find out the aetiology of tooth wear
good history taking
be compassionate, patient
dont blame the patient
diet diary
asking about oral hygiene regime
what is preventative advice given to tooth wear patients
fluoride toothpaste
fluoride mouthwash - alcohol free
diet modification - frequency, method of delivery
remineralisation - tooth mousse
toothbrushing instruction
signposting - CBT
referral to GMP - social services
why should complete dentures be avoided in tooth wear patients
bruxism doesnt stop
results in fractured dentures, resorbed ridges and ulceration
what is an overdenture
a denture that rests on one or more natural teeth or roots or an implant
what are the advantages of overdentures
correction of occlusion - reducing height of teeth and evening out the occlusion in tooth wear management
eases transition to denture
retains bone
maintains proprioception
psychological benefit
support for the denture
prevents XLA in MRONJ patients
what are some disadvanatages of over dentures
requires good oral health
not always maintained in care homes
risk of caries and periodontal disease
discomfort/infection
what advice is given to patients with overdentures
fluoride toothpaste on roots
denture hygiene advice
regular check ups - radiographs
good oral hygiene
what is the use of transitional dentures in tooth wear cases
when lack of posterior teeth and reduced OVD - can be used to increase OVD to create space for restorations
good way of seeing if patient can cope at an increased OVD - if not, cant make space
what is important when moving from transitional denture to definitive denture
OVD is not changed
only changed once to transitional - not changed after this
when are metal based dentures useful
for bruxists - likely to fracture dentures
can have metal in palate
or metal backing on teeth
what can be used to aid planning in tooth wear cases
impressions+ facebow
interocclusal record
mounted articulated casts on semi-adjustable articulator
diagnostic wax up
stent for build ups - can be for temporaries to aid consent process
temporary dentures (transitional)
clinical photographs
what features make it difficult to prepare a tooth with wear for an indirect restoration?
lack of occluso-gingival height
lack of occlusal space
severely compromised tooth
what can be used to enhance resistance form for an indirect prep?
having a ferrule present
place inlays and grooves on prep
what can be used to enhance retention form in indirect prep
parallel preps
retention grooves
why is material selection important for an indirect restoration in a tooth wear case
metal requires less space - so if short of space, this is more favourable
metal is also stronger so if the patient is a bruxist - more resistant
what surgery can be done to aid retention of indirect restoration
surgical crown lengthening - resect gingival margin so more tooth tissue is in mouth
what is important in the consent process for tooth wear cases
there is a high likelyhood of failure and repeated restorations
