Tooth wear Flashcards
What can causde tooth surface loss
Everything:
Caries, Trauma, Developmental Problems,
Tooth Wear
What are the types of tooth loss
PHYSIOLOGICAL tooth wear is the normal wear associated with normal function
PATHOLOGICAL tooth wear occurs if the remaining tooth structure or pulpal health is compromised or the rate of tooth wear is in excess of what would be expected for that age
Causes of tooth wear
Attrition
Abrasion
Erosion
Abfraction
What is attrition and where is it found normally
The physiological wearing away of tooth structure as a result of tooth to tooth contact
found on the occlusal and incisal contacting surfaces
What is the apperance of attrition
Early appearance is of a polished facet on a cusp or slight flattening of an incisal edge
Progression leads to reduction in cusp height and flattening of occlusal inclined planes
What is attritioon normally related to
Almost always related to a parafunctional habit (bruxism)
What is abrasion
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
Where is abrasion found
The site and pattern of tooth loss is related to the abrasive element
Commonest area is labial/buccal, cervical on canine and premolar teeth
What does abrasion look like
V shaped or rounded lesions
Sharp margin at enamel edge where dentine is worn away preferentially
What is the most common form of abrasion
Toothbrushing
What is erosion
The loss of tooth surface by a chemical process that does not involve bacterial action
What is the most common cause of pathological tooth wear
Erosion
What is erosion caused by
Cause by chronic exposure of dental hard tissues to acidic substances which can be extrinsic or intrinsic
What are the stages of erosion and what do they look like
Early stages enamel surface is affected, there is loss of surface detail, surfaces become flat and smooth
Later dentine becomes exposed
Preferential wear of dentine leads to ‘cupping’ of the occlusal surfaces of the molars and incisal edges of the anteriors
What can be signs of erosion
Increased translucency of incisal edges (can appear dark)
Base of lesion not in contact with opposing tooth
Amalgam and composite restorations stand proud of the tooth
There is no tooth staining present
What is abfraction
The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
Pathological loss of tooth substance at the cervical margin
What is abfraction caused by and what does it result in
biomechanical loading forces
Forces result in flexure and failure of the enamel and dentine at a location away from the loading
Is wear multifactorial
Almost all wear is
What increases with age
wear
What is most common type of wear in old people
physiological
What is succcessful management based on
An accuraste diagnoses
How do you prevent or reduce tooth loss
Recognise the problem is present
Grade its’ severity
Diagnose the likely cause or causes
Monitor the progression of the disease
-Is it active or historic
-Are preventative measures working or is active restorative treatment required
In medical history what could hell found out cause of wear
Medication with low pH
Medications which cause xerostomia
Eating disorder
Alcoholism
Heartburn
GORD
Hiatus Hernia
Rumination
Pregnancy
What are you looking for in the examination of a patient
E/O
Examine TMJ for problems
Examine muscles for hypertrophy
Examine mouth opening restriction and any deviation
Occlusion
Soft tissues
BPE
What wear indices are there
Smith and knight
BEWE
What is the smith and knight wear index
0- no enamel loss
1- loss of enamel surface characteristic
2- surface loss of enamel exposing dentine for less than 1/3 of surface , incisal loss of enamel, minimal dentine exposure
3- surface loss more than 1/3, incisal loss, substantial dentine exposure
4- pulled exposure or secondary dentine, incisal pulp/2nd dentine exposure
BEWE wear index
0- no erosive wear
1- initial loss of surface tension
2- distinct defect, hard tissue loss <50% of surface
3- hard tissue loss >50%
What special tests can you do for wear
L
Sensibility
Radiograph
Articulated study model
What patterns of tooth wear is there
Localised
Generalised
What falls under generalised pattern of tooth wear
Wear with loss of OVD
Wear without loss of OVD but with Spabe available
Wear without loss of OVD but with limited space
What is the immediate treatment to tooth wear
Deal with pain:
Sensitivity- desensitisation agents
Pulp extripation- if pulp compromised
Smooth sharp edges
Extract- pain and unrestorable
TMJ pain- important in attrition, acute symptoms need to be controlled
What is initial treatment for tooth wear
Stabilise existing dentition
Deal with caries
Deal with Perio
Once you have a diagnosis and have identified the primary causative factor
-Institute a preventative regime
What is the preventative treatment
Monitor and identify if wear progressing or historic
What is the prevention treatment for ABRASION
Remove the ‘foreign object or substance’ involved in causing the abrasive wear
Change toothpaste
Alter tooth brushing habits
Change habits
-Nail biting
How to fix cervical toothbrush abrasion
Simple RMGIC, GIC or composite restorations
Patient then wears through restoration and not the tooth
What is the prevention treatment for ATTRITION
More difficult as related to parafunctional habit- cognitive behavioural therapy
Could use splints
How do splints work in treatment for attrition
All work by being softer than teeth
Wear away in preference to tooth
Cause no damage to the opposing teeth
Soft splint can be used as a diagnostic device as wears fast and shows wear facets
What is a Michigan splint
Popular type of hard splint
Provides an ‘ideal occlusion’ with even centric stops
Has canine rise which provide disclusion in eccentric mandibular movements
What is the prevention treatment for EROSION
Habit changes (drink cans with straws, swilling drinks in mouth, diet advice)
Medical (control gastric acid, xerostomia, anorexia and bulimia)
What is the prevention treatment for abfraction
Assess occlusion and fill cavities with low modulus restorative materials (RMGIC, Flowable comp)
What is the first part of any dental wear treatment
Prevention and monitoring
For the active management of Maxillary Anterior Tooth Wear what 5 factors affects described on Tx
•The pattern of anterior maxillary tooth wear
•Inter-occlusal space
•Space required for the restorations being planned
•Quality and quantity of remaining tooth tissue, particularly enamel
•The aesthetic demands of the patient
Maxillary incisor wear can be categorised as what
Tooth wear palate only
Tooth wear involving palatial and incisal edges with reduced clinical crown height
Tooth wear limited to labial surfaces
If there is tooth wear with no increase in freeway space what happens
Compensation for the loss of tooth substance by dento alveolar bone growth
What is the Dahl technique
Method of gaining space in cases of localised tooth wear
-Originally a removable CoCr anterior bite plane
-Covering palatal surfaces and allowing occlusion on raised cingulum
-Resulted in posterior disclusion and increase in OVD of 2-3mm
-Occlusal contacts only on incisor/canine teeth
What happen in the Dahl technique
Over a period of 3-6 months you gain space between incisor teeth
-Interiors intrude
-Posteriors erupt
-Results in space between upper and lower anteriors allowing restoration with no need for occlusal reduction
When is Dahl technically not suitable
If no movement in 6mnths
Active Perio
TMJ problems
Post Ortho
Biphosphonates
Implants
Bridges
In anterior toothnwewr what do you look for if you think you can restore
Remaining enamel ‘ring of confidence’
What to do in lower anterior wear
Generally in conjunction with maxillary wear
More difficult to fix
Less enamel, smaller bonding area.
If possible improve aesthetics but do not increase OVD with lowers
If you have to build them up do this first before the uppers
Same techniques as upper
What approach should be used for treating generalised tooth wear and why
Adhesive approach
Used to assess a patient tolerance to a new occlusion as a medium term restoration
How to treat generalised tooth wear with excessive tooth wear & loss of OVD
Easiest to treat but least common
Splint or adhesive approach to see tolerance of new face height
Mixture of adhesive and conventional restorations and maybe dentures for post. Support
How to treat generalised tooth wear without loss of OVD but with limited space available
Complicated
May reorganise occlusion
Splint to increase occlusal height
Restoration of anterior and posterior teeth is then carried out at new occlusion
What’s the most severe type of generalised tooth wear
Generalised tooth wear without loss of OVD and no space available
