Tooth wear Flashcards

1
Q

what Is tooth wear and what can I be referred to?

A

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

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2
Q

how does tooth wear occur?

A

Due to a non carious process
- erosion, abrasion , attrition
defined by aetiology, severity , distribution

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3
Q

describe the 2009 dental health survey

A
  • 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
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3
Q

Describe the Dental health in the UK relating to tooth wear

A
  • 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
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4
Q

what is the definition of attrition

A
  • the loss of tooth substance or a restoration caused by tooth to tooth contact
    attrition = tooth to tooth
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4
Q

Describe the UK child dental health survey 2013

A

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

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5
Q

what is the definition of abrasion

A
  • the abnormal wearing away of tooth substance or a restoration by a mechanical process other than tooth contact
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6
Q

what is the definition of erosion?

A
  • the irreversible, progressive loss of dental hard tissue by an acidic chemical process not involving bacteria
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7
Q

what are the clinical presentations of attrition?

A
  • 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
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8
Q

what is bruxism

A
  • common parafunctional activity on response tor stress
  • associated tongue scalping /or cheek pidgin in active cases
  • masseteric hypertrophy in sever cases
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9
Q

what factors can increase risk of abrasion

A
  • tooth brushing
  • abrasive dentirfices
  • abrasive food particles
  • peicrings
  • habits
    nail biting
    tobacco chewing
    pipe smoking
    wire stripping
  • Iatrogenic
    unglazed porcelain
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10
Q

What are clinical presentaion of abrasion

A

general
- mainly cervical
-sharply defined margins
- smooth hard surface
- more rounded and shallow if associated with erosion

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11
Q

what is the theory of abfraction

A

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

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12
Q

describe abfrsction

A
  • deep V shaped notch
  • may be a single tooth affected
  • toothbrush unable to contact base of defect
  • defects may be sub gingival
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13
Q

how is erosion classified?

A

classified according to the source of the acid
- Intrinsic (acid coming up)
- Extrinsic (acid going in)

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14
Q

what is the clinical presentation of erosion?

A

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

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15
Q

How does erosion differ from caires?

A

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

16
Q

List some intrinsic acids that can lead to regurgitations erosion

A
  • Gastro oesophageal reflux (GOR)
  • Vominting (voluntary/involuntary)
  • eating disorders
    -pregnancu
  • Metabolic/endocrin
    -GI disorders
  • Drug induced
  • Alcoholism
17
Q

List some GOR - symptoms

A
  • 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
18
Q

how many in the UK have and eating disorder

A

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

19
Q

Describe anorexia nervosa

A
  • ’ 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
20
Q

Describe Bulimia nervosa

A
  • 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
21
Q

List some dietary acid sources

A
  • 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
22
Q

what are the important factors to consider with dietary erosion

A

amount
frequency
method of consumption
timing of consumption

23
Q

what are other potential contributors to erosion

A

Oral hygiene products
- mouthwashes
- saliva substitues
Medications
- vitamin C
- asthma inhalers
-those affecting saliva quantity

24
Q

what are pre disposing factors to tooth wear

A

saliva
- flow rate
-PH
-Buffering capacity
- presence of salivary mcuins
- clearance rates from different oral sites
- low saliva flow is a risk for erosion

25
Q

what is xerostomia and what causes it?

A
  • results from reduced saliva secretion
    caused by
  • drugs (antidepressants, antihistamines, diuretics)
    dehydration
    anxiety
    Sjogrens syndrome
    radiotherapy of the head and neck
25
Q

what is the initial management of tooth wear

A
  • identify present and severity of tooth wear
  • identify aetiology
  • monitoring
  • prevention
26
Q

how do you asses the severity of toothwear

A
  • symptoms
  • affecting enamel/dentine/pulp
  • Loss of crown height
  • Structural integrity compromised
    -Aesthetic concern
27
Q

What are the clinical consequences of NCTTL

A
  • one or more of the following:
    -change in appearnace
    -pain and/or sensitvity
  • Loss of OVD and/or lack of occlusal stability
    -Functional difficulties
28
Q

How do you find the aetiology of a patints toothwear

A
  • Patient history
    -food drink
  • medication
  • medical history
    -Habits
    Clinical appearance
29
Q

What are the severly worn dentition difficulties

A
  • lack of tooth tissue
  • plural problems
  • aesthetic compromise
  • Lack of space for restoration
    -Occlusal changes
    -Soft tissue changes
  • Habitual/ etiological factors
30
Q

what are the habitual/ etiological factors

A

damage to restorations
further wear of teeth

31
Q

how do we find out if tooth wear is progressing

A

Clues
- sensitivity
- Staining
Monitoring

32
Q

How do we monitor toothwear?

A

Study models
Silicone index
Clinical photographs
Description
Measurement
- crown height
- gingival margin

33
Q

how is erosion prevented?

A
  • Diet advice
  • Avoid brushing immediately after acidic foods
  • Control of GORD/eating disorders
  • Water and sodium bicarbonate
34
Q

How do we gain desensitataion and protection from toothwear ?

A

Fluoride mouthiness and varnish
- Flruodie paste- GelKam
-Low abrasivity toothpaste
- Sugar free chewing gum
- Dentine bonding agents
-‘ ANti eroison’ toothpaste
- tooth mousse

35
Q

how is attrition prevented

A
  • patient awareness/education
  • splints
  • composite
36
Q

what are soft splints?

A
  • 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
37
Q

How is abrasion prevented?

A

Patient education/habits
OHI
bristle stiffness
brushing force
frequency
Paste abrasivity
Abrasive restorations

38
Q

How is NCTTL managed?

A
  • 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
39
Q

when should dentists intervene to tooth wear

A
  • Early rather than late
  • Protect pulp
  • Aesthetics
  • Functional problems
  • loss of structural integrtiy
    -Prevention of further complex treatment
  • Patient wishes/coooperation.