Tooth wear Flashcards
4 types of tooth wear
Attrition
Abrasion
Erosion
Abfraction
Attrition definition
The physiological wearing away of tooth structure as a result of tooth to tooth contact (parafunctional habit).
Abrasion definition
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.
Erosion definition
Loss of tooth surface by a chemical process that does not involve bacterial action
How can you tell the difference between erosion and attrition?
Fillings are un-affacted in erosion - tooth will dissolve around the filling.
Filling will be worn down the same as the tooth in attrition.
Where is common to see attritive lesions?
Occlusal and incisal contacting surfaces.
What restorative measure could be used to prevent cervical toothbrush abrasion?
Simple RMGIC, GIC or composite restorations can almost be considered as a preventative measure.
Why do you not use splints for erosion?
Ineffective.
Makes erosion worse by holding the acid in place.
How to prevent attrition?
CBT or hypnosis
Splint - soft or hard.
- Soft can be used as a diagnostic device and wears rapidly to show scraps and gouges in surface of splint.
- Hard splint are more robust for long-term.
How to prevent erosion?
Dietary modification
Habit changes e.g. not swilling drinks around mouth, drink from straw.
Medical - GORD, bulimia, xerostomia
What is best filling for cervical tooth wear?
RMGIC over composite.
Composite is better aesthetically but RMGIC better in every other way.
Common features of carbonated drink erosion?
Incisal erosion in upper centrals
Cupping on lower molars
Palatal erosion on upper incisors
Sensitivity
IP caries and buccal white spot/brown spot caries
Common features of a bruxist
Significant wear throughout dentition
Repeated restoration failure
Root fractures
Often onset in early adulthood
Progressive
Common features of wear from restorations
wear is worse than you would expect as restorative materials can wear tooth substance down quickly
What features would indicate parafunction without obvious tooth wear?
Multiple cusp fracture
Multiple cracks around restorations
Root fractures in unrestored teeth
What are extrinsic factors that contribute to erosion?
Carbonated drinks
Sports drinks
Alcoholic acidic drinks e.g. wine, cider
Citrus drinks
Acidic fruits
Acidic sweets
Pickles
Drugs - methamphetamine
What are intrinsic factors that contribute to erosion?
Eating disorders - bulimia nervosa
GORD
Barrett’s oesophagus
Common features of erosion from eating disorders?
Palatal erosion on upper teeth
Polished restorations
Erosion around restorations
Sensitivity
Caries - high calorie/ sugar intake with repeated vomiting
Altered taste - sometimes
Halitosis - sometimes
What are abrasive behaviours?
TOOTHBRUSH ABRASION
Oral self-harm
Tongue studs
Occupational
Unusual habits
What things must you consider when toothbrush abrasion?
Localised or generalised?
Frequency and duration
Bristle and toothpaste abrasiveness
Brushing technique instruction
Electric vs manual
Combined with other issues e.g. eating disorder?
Common preventative advice for tooth-wear?
Fluoride - high-dose toothpaste, alcohol-free mouthwash
Dietary modification - frequency and quantity, method of delivery, elimination of bad foods
Re-mineralisation - tooth mousse
Sugar-free gum
What are some common modifying factors of tooth wear?
Lack of posterior support
Occlusion
Restorations
Erosion and abrasion
Stress and anxiety
What are some advantages of overdentures?
Correction of occlusion and aesthetics
Support - tooth and mucosal support in saddle areas
Tooth wear management
Preservation of ridge form
Proprioception
Denture retention
Can be used with precision attachments
Psychological benefits
Useful in elderly patients
Eases transition to edentulism
MRONJ and radiotherapy patients - AVOIDS EXTRACTIONS
Disadvantages of overdentures
Need good OH
Increased caries/ periodontal problems
Denture fracture
Discomfort/ infection
Care home - more difficult to maintain here
Potentially more traumatic extractions in the future if only root left
What is the purpose of a transitional denture?
Transitional dentures can increase the OVD in cases where there is poor posterior support to create space for restorations
What does BEWE stand for and what are the scores?
Basic erosive wear exam
0 - no erosive tooth-wear
1 - initial loss of surface texture
2 - distinct defect - hard tissue loss involving <50% of surface area
3 - hard tissue loss involving >50%
Explain what the DAHL technique is?
Way of treating localised anterior tooth-wear
1. Use CoCr anterior bite plane on the palatal surfaces to prop open occlusion
2. Wear 3-6 months - allows for posterior disclusion & increased OVD 2-3mm
3. Anterior composite build-ups
If doesn’t work within 6 months - won’t work
