Tooth wear Flashcards
what Is tooth wear and what can I be referred to?
Referred to as Non- Carious tooth, Tissue loss or Non-carious tooth surface loss
-Normal process that Occurs throughout life
- Pathological when rate of loss or degree of destruction is excessive
- May lead to problems with function, aesthetics or sensitivity
how does tooth wear occur?
Due to a non carious process
- erosion, abrasion , attrition
defined by aetiology, severity , distribution
describe the 2009 dental health survey
- Moderate tooth wear has increased from 11% in 1998 to 15% in 2009
although severe wear remains rare, Increase in moderate toothier in younger adults
Describe the Dental health in the UK relating to tooth wear
- ageing dentate population with increasing evidence of cumulative effects of toothier
- Erosion on the increase in younger population
-NCTTL increasing in prevalence and occupying large amounts of practitioner time - Can be complex to manage in later stages but early treatment simple and effective
what is the definition of attrition
- the loss of tooth substance or a restoration caused by tooth to tooth contact
attrition = tooth to tooth
Describe the UK child dental health survey 2013
33% of 5yd have evidence of TSL on one or more buccal surfaces of the primary upper incisors
4% involving dentine or pulp
57% of 5 old had TSL of the lingual surfaces,16% progressing to dentine or pulp
what is the definition of abrasion
- the abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact
what is the definition of erosion?
- the irreversible, progressive loss of dental hard tissue by an acidic chemical process not involving bacteria
what are the clinical presentations of attrition?
- enamel and dentine wearing at the same rate
- localised facets, flattened cusps/incisal edges
- worn surfaces ‘mate’ in closed eccentric movements
- shiny amalgam in areas of contact
- slow process so secondary dentine forms and usually not sensate
- possible massetric hypertrophy
- Possible fractured cusps and/or restorations
-increased risk of tooth mobility
what is bruxism
- common parafunctional activity on response tor stress
- associated tongue scalping /or cheek pidgin in active cases
- masseteric hypertrophy in sever cases
what factors can increase risk of abrasion
- tooth brushing
- abrasive dentirfices
- abrasive food particles
- peicrings
- habits
nail biting
tobacco chewing
pipe smoking
wire stripping - Iatrogenic
unglazed porcelain
What are clinical presentaion of abrasion
general
- mainly cervical
-sharply defined margins
- smooth hard surface
- more rounded and shallow if associated with erosion
what is the theory of abfraction
Theory of abstraction supposes that occlusal forces cause compressive and tensile stresses, which are concentrated at the cervicla region of the tooth and cause miucrofractor of cervical enamel rods
describe abfrsction
- deep V shaped notch
- may be a single tooth affected
- toothbrush unable to contact base of defect
- defects may be sub gingival
how is erosion classified?
classified according to the source of the acid
- Intrinsic (acid coming up)
- Extrinsic (acid going in)
what is the clinical presentation of erosion?
Anterior teeth
- loss of surface anatomy, smooth enamel surface
- increased incise translucency
- chipping of incised edges
- palatal hollows
- areas where the enamel is absent
- exposure of the pulp
- intrinsic often affects the palatal surfaces, extrinsic the labial
Posterior teeth
- loss of surface anatomy
- cusp cupping
- proud restorations
- darkening of colour
- plural exposure rare in permanent teeth
General
- Worn surfaces not in contact in closed eccentric movements
How does erosion differ from caires?
In CARIES- plaque acid leads to demineralisations but the organic matrix is not affected
In EROSION- Extrinsic/Intrinsic acid leads to demineralisation and loss of the organic matrix
List some intrinsic acids that can lead to regurgitations erosion
- Gastro oesophageal reflux (GOR)
- Vominting (voluntary/involuntary)
- eating disorders
-pregnancu - Metabolic/endocrin
-GI disorders - Drug induced
- Alcoholism
List some GOR - symptoms
- heart burn
- retrosternal discomfort
-epigastric pain - Dysphagia
- Chronic cough
-Sore throat - Hoarseness
- Sour taste at back of throat
however in many cases may be silent reflux
how many in the UK have and eating disorder
over 700,000
90% females
- underestimate
-risk of onset higher for adolescents and young adults
most ocmmon
- Atypical eaten disorders
- binge eating disorders
- Bullimia nervosa
-Anorexia nervosa
Describe anorexia nervosa
- ’ aversion to food’
- restricting and binge/prufing types
- overall incidence of 6 per 100,000 population with highest incidence age 15-19 years
- Prevalence in young women of 0.5-1%
- Female to male ration 10;1
-More than 15% below ideal body weight
Describe Bulimia nervosa
- over eating followed by inappropriate compensatory behaviour e.g purging
- prevalence in Europe less than 1-2 %
- peak age of onset 15-25 years
Email to male ratio 10;1 - within 10% of ideal body weight or grossly overweight
List some dietary acid sources
- acid drinks and food
- soft drinks - fruit juice, carbonated and still
- alcoholic drinks
- fresh fruit, fruit pulp, dared fruit
- pickles, vinegar, acetic acid added to crisps
- Yoghurts and sauces
- Fruit and herbal teas
- Energy/sports supplements
what are the important factors to consider with dietary erosion
amount
frequency
method of consumption
timing of consumption
what are other potential contributors to erosion
Oral hygiene products
- mouthwashes
- saliva substitues
Medications
- vitamin C
- asthma inhalers
-those affecting saliva quantity
what are pre disposing factors to tooth wear
saliva
- flow rate
-PH
-Buffering capacity
- presence of salivary mcuins
- clearance rates from different oral sites
- low saliva flow is a risk for erosion
what is xerostomia and what causes it?
- results from reduced saliva secretion
caused by - drugs (antidepressants, antihistamines, diuretics)
dehydration
anxiety
Sjogrens syndrome
radiotherapy of the head and neck
what is the initial management of tooth wear
- identify present and severity of tooth wear
- identify aetiology
- monitoring
- prevention
how do you asses the severity of toothwear
- symptoms
- affecting enamel/dentine/pulp
- Loss of crown height
- Structural integrity compromised
-Aesthetic concern
What are the clinical consequences of NCTTL
- one or more of the following:
-change in appearnace
-pain and/or sensitvity - Loss of OVD and/or lack of occlusal stability
-Functional difficulties
How do you find the aetiology of a patints toothwear
- Patient history
-food drink - medication
- medical history
-Habits
Clinical appearance
What are the severly worn dentition difficulties
- lack of tooth tissue
- plural problems
- aesthetic compromise
- Lack of space for restoration
-Occlusal changes
-Soft tissue changes - Habitual/ etiological factors
what are the habitual/ etiological factors
damage to restorations
further wear of teeth
how do we find out if tooth wear is progressing
Clues
- sensitivity
- Staining
Monitoring
How do we monitor toothwear?
Study models
Silicone index
Clinical photographs
Description
Measurement
- crown height
- gingival margin
how is erosion prevented?
- Diet advice
- Avoid brushing immediately after acidic foods
- Control of GORD/eating disorders
- Water and sodium bicarbonate
How do we gain desensitataion and protection from toothwear ?
Fluoride mouthiness and varnish
- Flruodie paste- GelKam
-Low abrasivity toothpaste
- Sugar free chewing gum
- Dentine bonding agents
-‘ ANti eroison’ toothpaste
- tooth mousse
how is attrition prevented
- patient awareness/education
- splints
- composite
what are soft splints?
- Vacuum formed on model of one arch
- Usually lower in bruxism cases
prevention of wear
protection of new restorations - Can be used as an upper fluoride/sodium bicarbonate tray
-Full coverage - Quick and easy
How is abrasion prevented?
Patient education/habits
OHI
bristle stiffness
brushing force
frequency
Paste abrasivity
Abrasive restorations
How is NCTTL managed?
- identify the cause if possible and assess the long term prognosis forth patients dentition
- Institute preventive measures to try to control TSL
- Monitor TSL
- Operatiev treatment if required
- Review
when should dentists intervene to tooth wear
- Early rather than late
- Protect pulp
- Aesthetics
- Functional problems
- loss of structural integrtiy
-Prevention of further complex treatment - Patient wishes/coooperation.
