tooth wear Flashcards
why is aetiology important
can reduce further wear
allows planning for problems and failures
dictates prognosis
allows sign posting
enhances consent
what factors contribute to attrition
lack of posterior teeth
occlusion (edge to edge or deep OB)
ceramic crowns
combination with erosion
stress
what are the common intra occlusal features of bruxists
significant wear throughout dentition
repeated restoration failures
root fractures (worrying in virgin teeth)
often onset in early adulthood
rapid progression
what is physiological tooth wear
wear that is expected given the age of the patient
what are the modifying features of erosion
extrinsic acids (sports drinks, fizzy drinks, inhalers, swimming, alcohol, fruit)
intrinsic acids (poorly controlled diabetes, bulimia, GORD, Barrett’s oesophagus)
high frequency of acids
what are common intra oral features of high carbonated drink intake
incisal erosion on upper centrals
cupping on lower molars
palatal erosion on upper incisors
sensitivity
interproximal caries
what are the common intra oral features of eating disorders
palatal erosion on upper teeth
polished restorations
erosion around restorations
sensitivity
caries
may have altered taste or halitosis
what behaviours can contribute to abrasion
toothbrushing habits (OCD, cheap electric toothbrush with no pressure stop, canines and premolars most affected, poor brushing technique)
tongue studs (lingual wear)
occupational
what individualised interventions could you perform to reduce tooth wear
high fluoride use, alcohol free mouthwash
toothbrushing instruction
personalised diet advice (reduce frequency of acids, elimination and addition)
remineralisation (tooth mousse)
splint therapy
signposting (CBT, hypnotherapy)
referral to GMP or psychiatrist
manage patient expectations
how can you monitor tooth wear
3D scan
silicone index
photos
casts
tooth wear index
basic erosive wear exam
anterior clinical erosive classification
describe the use of the tooth wear index by smith and knight
4 surfaces of the teeth are scored based on the level of enamel/dentine/contour lost
comprehensive index usually used for research as it is time consuming in practice and can easily over or under estimate multifactorial wear
describe the use of the basic erosive wear exam
record the most severely affected surface of each sextant and add the 6 scores together
guides management
simple, reliable, easy, quick
describe the use of the anterior clinical erosive (ACE) classification
patient is grouped into one of six classes based on 5 parameters relevant to treatment and prognosis
specific to anterior maxillary teeth only
most severely affected tooth decides classification
developed to be easier than BEWE
why should you avoid complete dentures in tooth wear patients
bruxism doesnt stop so can lead to fractured dentures, ridge resorption due to heavy occlusal load, pain and ulceration under complete dentures
what are the advantages of overdentures
corrects occlusion
aesthetics
psychological benefit of still having teeth
transition to edentulism
avoids extraction in patients at risk of MRONJ
preserves the alveolar ridge
what is the definition of an overdenture
a removable prosthesis that rests on natural teeth, natural roots or implants
what are the disadvantages of overdentures
need good oral hygiene
can make extractions harder as carious roots are now at a sub alveolar level
can fracture in bruxism patients
what is the function of transitional dentures
increase OVD in cases where poor posterior support to create space for restorations
after transitional dentures have been worn for a few months and the patient tolerates the dentures and the new OVD definitive dentures can be made to the new OVD
what are the advantages of metal based dentures in tooth wear cases
CoCr backing to denture teeth is stronger than acrylic
why would you use bridgework to simplify small saddles in tooth wear cases
the pontic of the bridge is metal ceramic which is stronger than the acrylic denture tooth that could break off
need to ensure it is not involved in protrusive or excursive movements otherwise it could fail
why is occlusal rehabilitation commonly needed in tooth wear cases
often the occlusion is unstable and there is a lack of sufficient index teeth
it is usually more challenging to record the occlusion
what planning is needed for rehabilitation in toothwear cases
impressions and facebow
mounted casts on a semi adjustable articulator (with or without surveying)
high quality interocclusal record at new and old OVD
diagnostic wax ups
sents
transitional/ temporary dentures
clinical photographs
how can you increase retention for indirect restorations in tooth wear cases
grooves parallel to the path of insertion
ferrule
parallel preps
metal on biting surfaces as it is stronger in thin sections
surgical crown lengthening
cores
why is tooth preparation for indirect restorations in tooth wear cases difficult
lack of occluso-gingival height leaves very little retention and resistance form for crown prep
lack of occlusal space, esp on the palatal of the upper incisors
severely compromised tooth
what factors should be considered during dental demolition
operator safety (eye protection, surgical gloves to protect from sharp metal edges)
patient safety (airway, eye protection)
assess ease of demolition
repeat endo
posts
extractions
can you achieve health and aesthetic objectives
valid consent - risks and benefits (health and aesthetics)
be clear about longevity and cycles of replacement
what basic technique should you under take for dental demolition
porcelain - coarse diamond
metal - gold cutting bur
chisel whole way up buccal surface
high volume suction
non precious metal is harder to cut through than precious metal
keep bridges as intact as possible to use as temporary
take a pre op impression to make temporary
what is a failing dentition
a dentition where deteriorating teeth, restorations or oral health means a loss of adequate basic oral functions such as mastication and aesthetics is inevitable if untreated
what are the keys to success when managing failure
comprehensive history and exam
thorough planning
seek advice if needed
prevention
avoid over ambitious treatment
effective communication
keep plans simple
have an effective maintenance strategy and regularly reassess
what is effective communication when managing failure
effective listening
honesty and transparency
take into account the patient’s wishes
address difficult issues
seek advice
document discussions
be assertive and compassionate
patience
avoid patient led treatment
have a holistic approach to treatment
how would you break bad news to patients
SPIKES
Set up interview (mental and physical prep)
Perception (assess what the patient knows about the medical situation)
Invitation (ask how much they want to know)
Knowledge (give the medical facts)
Emotion (respond to patient’s emotions)
Strategy and summary (negotiate a concrete follow up step)
