Tooth wear

Question 1

4 types of tooth wear

Answer 1

Attrition
Abrasion
Erosion
Abfraction

Question 2

Attrition definition

Answer 2

The physiological wearing away of tooth structure as a result of tooth to tooth contact (parafunctional habit).

Question 3

Abrasion definition

Answer 3

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.

Question 4

Erosion definition

Answer 4

Loss of tooth surface by a chemical process that does not involve bacterial action

Question 5

How can you tell the difference between erosion and attrition?

Answer 5

Fillings are un-affacted in erosion - tooth will dissolve around the filling.
Filling will be worn down the same as the tooth in attrition.

Question 6

Where is common to see attritive lesions?

Answer 6

Occlusal and incisal contacting surfaces.

Question 7

What restorative measure could be used to prevent cervical toothbrush abrasion?

Answer 7

Simple RMGIC, GIC or composite restorations can almost be considered as a preventative measure.

Question 8

Why do you not use splints for erosion?

Answer 8

Ineffective.
Makes erosion worse by holding the acid in place.

Question 9

How to prevent attrition?

Answer 9

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.

Question 10

How to prevent erosion?

Answer 10

Dietary modification
Habit changes e.g. not swilling drinks around mouth, drink from straw.

Medical - GORD, bulimia, xerostomia

Question 11

What is best filling for cervical tooth wear?

Answer 11

RMGIC over composite.
Composite is better aesthetically but RMGIC better in every other way.

Question 12

Common features of carbonated drink erosion?

Answer 12

Incisal erosion in upper centrals
Cupping on lower molars
Palatal erosion on upper incisors
Sensitivity
IP caries and buccal white spot/brown spot caries

Question 13

Common features of a bruxist

Answer 13

Significant wear throughout dentition
Repeated restoration failure
Root fractures
Often onset in early adulthood
Progressive

Question 14

Common features of wear from restorations

Answer 14

wear is worse than you would expect as restorative materials can wear tooth substance down quickly

Question 15

What features would indicate parafunction without obvious tooth wear?

Answer 15

Multiple cusp fracture
Multiple cracks around restorations
Root fractures in unrestored teeth

Question 16

What are extrinsic factors that contribute to erosion?

Answer 16

Carbonated drinks
Sports drinks
Alcoholic acidic drinks e.g. wine, cider
Citrus drinks
Acidic fruits
Acidic sweets
Pickles
Drugs - methamphetamine

Question 17

What are intrinsic factors that contribute to erosion?

Answer 17

Eating disorders - bulimia nervosa
GORD
Barrett’s oesophagus

Question 18

Common features of erosion from eating disorders?

Answer 18

Palatal erosion on upper teeth
Polished restorations
Erosion around restorations
Sensitivity
Caries - high calorie/ sugar intake with repeated vomiting
Altered taste - sometimes
Halitosis - sometimes

Question 19

What are abrasive behaviours?

Answer 19

TOOTHBRUSH ABRASION
Oral self-harm
Tongue studs
Occupational
Unusual habits

Question 20

What things must you consider when toothbrush abrasion?

Answer 20

Localised or generalised?
Frequency and duration
Bristle and toothpaste abrasiveness
Brushing technique instruction
Electric vs manual
Combined with other issues e.g. eating disorder?

Question 21

Common preventative advice for tooth-wear?

Answer 21

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

Question 22

What are some common modifying factors of tooth wear?

Answer 22

Lack of posterior support
Occlusion
Restorations
Erosion and abrasion
Stress and anxiety

Question 23

What are some advantages of overdentures?

Answer 23

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

Question 24

Disadvantages of overdentures

Answer 24

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

Question 25

What is the purpose of a transitional denture?

Answer 25

Transitional dentures can increase the OVD in cases where there is poor posterior support to create space for restorations

Question 26

What does BEWE stand for and what are the scores?

Answer 26

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%

Question 27

Explain what the DAHL technique is?

Answer 27

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