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FINALS - Tooth Wear > Tooth Wear 2 > Flashcards

Tooth Wear 2 Flashcards

1
Q

What is the overview concept for Tooth wear cases?

A

Diagnosis
Treatment Planning
PREVENTION
PASSIVE MANAGEMENT
Localised Anterior tooth wear
Dahl Concept

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2
Q

What is the correct terminology when diagnosing Pattern of tooth wear?

A
  • Localised
  • Generalised
    - Wear with loss of OVD
    - Wear without loss of OVD but with space available
    - Wear without loss of OVD but with limited space
  • Dento-alveolar compensation
    - Important in treatment planning
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3
Q

What is the immediate treatment for any pt with tooth wear?

A
  • Deal with pain

Sensitivity
- Desensitising agents. Fluorides, bonding agents GIC coverage of exposed dentine
- Pulp extripation
- If wear has compromised pulpal health
- Smooth sharp edges
- Prevent trauma to cheeks and tongue
- Extraction
- Pain from unrestorable/non-functional tooth
- TMJ pain
- Important in attrition, acute symptoms need to be controlled

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4
Q

What is the Initial treatment for pt with tooth wear?

A
  • Stabilise existing dentiion
  • Deal with Caries
  • Deal with Perio condition
  • Oro-mucosal
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5
Q

What is the next stage after you have a diagnosis and have identified primary causative factor?

A
  • Implement a preventative regime
  • Txt without prevention will fail
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6
Q

What is the key element in prevention?

A
  • Removal of cause
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7
Q

What can you identify if you are monitoring tooth wear adequately?

A
  • Have a baseline
  • Can identify if wear is progressing or if it is historic
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8
Q

What are some preventative measures used for Abrasion cases?

A
  • Remove the ‘foreign object or substance’ involved in causing the abrasive wear
  • Change toothpaste
  • Alter tooth brushing habits
  • Change habits
    - Nail biting
    - Wire stripping
    - Piercing biting
    - Pen chewing etc
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9
Q

What is a preventative measure for cervical tooth brush abrasion?

A
  • RMGIC, GIC or comp restoration placed in cavity
  • Pt wears through your restoration not their own tooth
  • RMGIC has best survival rate
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10
Q

Pros and cons to composite or RMGIC for cervical toothbrush abrasion

A
  • RMGIC has highest survival rate
  • Composite has better aesthetics but may compromise retention and can give 2 caries
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11
Q

What is a parafunctional habit usually in response to?

A
  • Life stressors
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12
Q

What is a preventaive measure for Attrition due to parafunctional habit?

A
  • Cognitive behavioural therapy
  • Hypnosis
  • Splints
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13
Q

What are some benefits to splints to be used as a preventative measure for attrition?

A
  • Work by being softer than teeth
  • Wear away instead of tooth
  • Cause no damage to opposing teeth
  • May be habit breaker
  • Can be used a diagnostic device (splint will wear rapidly and show wear facets as scrapes if pt grinds)
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14
Q

What are some advantages to Michigan splints?

A
  • Type of hard splint
  • Provides ideal occlusion with even centric stops
  • Has canine rise which provide disclsuion in eccentric mandibular movements (canine guidance)
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15
Q

What type of tooth wear would you not use a splint for?

A
  • Erosion
  • Acid Weakens the tooth structure beneath the splint , causing more erosion
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16
Q

What are some preventative measures for erosion cases?

A
  • Fluorides e.g. toothpastes and mouthwashes - pt may need to try few different ones for them until it works
  • Desensitising agents like sensodyne or duraphat (helps with symptomatic relief)
17
Q

What Habit changes can be discussed with the pt in cases of erosion?

A
  • Swilling drinks around mouth
  • Drinking from cans (use a straw instead)
  • Rumination
  • Eating too many fruits a day
  • Vegan diet ?
  • Sports drinks and gels
18
Q

What preventative medical things can be done for erosion cases?

A
  • Control gastric acid (GORD, Reflux, Haitus Hernia)
  • Xerostomia
  • Anorexia and Bulimia
19
Q

What are some preventative measures for Abfraction cases?

A
  • Assess occlusaion on teeth with lesions and consider occlusal equilibration
  • Fill cavities with low modulus restorative materials like RMGIC and flowable composite
20
Q

what is meant by passive management for toothwear cases?

A
  • Prevention and monitoring is first part of any txt for dental wear
  • Most pt in this for 6 months
  • For many the preventative regime is enough
21
Q

When do you progress to active management from passive management in tooth wear cases?

A
  • Simple restorative intervention like covering ecposed dentine, filling cupped defects in molars and incisors
  • If wear leads to further complication
  • If aesthetics gone beyong pt acceptability
  • If leaving intervention may cause more complex txt to be required
  • Very pt specific
22
Q

What is the goal of active managent?

A
  • Preserve remaining tooth structure
  • Pragmatic improvement in aesthetics
  • Functioning occlusion
  • Stability
23
Q

What five factors determine the decision on txt and restoration for maxillary anterior tooth wear?

A
  • 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
24
Q

How is Maxillary anterior tooth wear categorised?

A
  • Tooth wear limited to the palatal surfaces only
  • Tooth wear involving the palatal and incisal edges with reduced clinical crown height
  • Tooth wear limited to labial surfaces
25
Q

What are some examples of cases for Maxillary anterior tooth wear where there is adequate inter-incisal space? (Very rare but the easiest to treat)

A
  • If teeth wear rapidly and there is no time for alveolar compensation
  • Where there is an anterior open bite
  • Where there is an increased overjet
    - In these cases there can be available space for restorations with no change in OVD
26
Q

What is the most common findings for Maxillary anterior tooth wear?

A
  • No increase in freeway soace
  • Compensation for loss of tooth substance by dento-alveolar bone growth
  • Maintains masticatory efficiency but leaves no space for restorations
27
Q

What are some txt options to make space for maxillary anterior tooth wear?

A
  • Increase OVD
  • Occlusal reorganisation from ICP to RCP
  • Surgical crown lengthening
  • Elective RCT and post crowns (Very destructive)
  • Conventional orthodontics (lengthy txt)
28
Q

What are some pros and cons to increase OVD?

A
  • Multiple posterior extra-coronal restorations
  • Reorganised approach
  • It is complex, destructive and expensive
29
Q

What is surgical crown lengthening?

A
  • Exposes more of the crown for retention of final restoration
  • Repositioning of gingivae apically generally with removal of bone
  • Can lead to sensitivity
30
Q

What is the DAHL technique?

A
  • Method of gaining space in cases of localised tooth wear
  • Faster effect and better in younger pt
  • If no movement in 6 months then its not going to work
  • Succes rate 90+%
31
Q

When is the DAHL technique not suitable?

A
  • Active periodontal disease
  • TMJ problems
  • Post Orthodontics
  • Biphosphonates (poor bone turnover, rely on this )
  • If dental implants present (ankylosis of implants arent going to erupt so doesnt work)
  • If existing conventional bridges
32
Q

Outline the DAHL technique?

A
  • Cover the palatal surface with composite of anteriors
  • Allows for occlusion on raised cingulum
  • Results in posterior disclusion and incread in oVD 2-3mm
  • Occlusal contacts only on incisor/canine teeth
  • ** Slide 41
33
Q
A

FINALS - Tooth Wear (8 decks)

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