Tooth Wear

Question 1

What is the importance of aetiology in tooth wear

Answer 1

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

Question 2

what are factors in rate of attrition

attrition has a spectrum of rates - physiological to bruxist

Answer 2

lack of posterior teeth
occlusion - deep overbite
restorations - porcelain is abrasive
erosion and abrasion combination
stress & anxiety - parafunction

Question 3

what are common features of a bruxist

Answer 3

significant wear throughout dentition
repeated restoration fracture
root fracture

Question 4

give examples of extrinsic and intrinsic acids

Answer 4

extrinsic - carbonated drinks, sports drinks, cirtus drinks & fruit, acidic sweets, pickles, alcohol
intrinsic - GORD, bulimia, remunation

Question 5

what are modifying factors affecting the rate of progression of erosion

Answer 5

amount and frequency
level of control
psychosocial

Question 6

what common features seen in erosion due to acidic drinks

Answer 6

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

Question 7

what are common features of an eating disorder

Answer 7

palatal erosion of upper teeth
dentine exposed with enamel halo
polished restorations
erosion around restorations
altered taste and hallitosis

Question 8

what are some causes of abrasion

Answer 8

tongue stud
toothbrushing
occupational - electrictian, joiner

Question 9

what are some features to consider with abrasion due to toothbrushing

Answer 9

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

Question 10

how can an alcoholic present with tooth wear

Answer 10

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

Question 11

how can you find out the aetiology of tooth wear

Answer 11

good history taking
be compassionate, patient
dont blame the patient
diet diary
asking about oral hygiene regime

Question 12

what is preventative advice given to tooth wear patients

Answer 12

fluoride toothpaste
fluoride mouthwash - alcohol free
diet modification - frequency, method of delivery
remineralisation - tooth mousse
toothbrushing instruction
signposting - CBT
referral to GMP - social services

Question 13

why should complete dentures be avoided in tooth wear patients

Answer 13

bruxism doesnt stop
results in fractured dentures, resorbed ridges and ulceration

Question 14

what is an overdenture

Answer 14

a denture that rests on one or more natural teeth or roots or an implant

Question 15

what are the advantages of overdentures

Answer 15

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

Question 16

what are some disadvanatages of over dentures

Answer 16

requires good oral health
not always maintained in care homes
risk of caries and periodontal disease
discomfort/infection

Question 17

what advice is given to patients with overdentures

Answer 17

fluoride toothpaste on roots
denture hygiene advice
regular check ups - radiographs
good oral hygiene

Question 18

what is the use of transitional dentures in tooth wear cases

Answer 18

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

Question 19

what is important when moving from transitional denture to definitive denture

Answer 19

OVD is not changed
only changed once to transitional - not changed after this

Question 20

when are metal based dentures useful

Answer 20

for bruxists - likely to fracture dentures
can have metal in palate
or metal backing on teeth

Question 21

what can be used to aid planning in tooth wear cases

Answer 21

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

Question 22

what features make it difficult to prepare a tooth with wear for an indirect restoration?

Answer 22

lack of occluso-gingival height
lack of occlusal space
severely compromised tooth

Question 23

what can be used to enhance resistance form for an indirect prep?

Answer 23

having a ferrule present
place inlays and grooves on prep

Question 24

what can be used to enhance retention form in indirect prep

Answer 24

parallel preps
retention grooves

Question 25

why is material selection important for an indirect restoration in a tooth wear case

Answer 25

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

Question 26

what surgery can be done to aid retention of indirect restoration

Answer 26

surgical crown lengthening - resect gingival margin so more tooth tissue is in mouth

Question 27

what is important in the consent process for tooth wear cases

Answer 27

there is a high likelyhood of failure and repeated restorations