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Restorative > Tooth Wear > Flashcards

Tooth Wear Flashcards

0
Q

How can direct composites be used in tooth wear?

A

Used as an interim during stabilisation
Or
Used permanently

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1
Q

In which patient group should you be cautious of using the Dahl approach in? Reference

A

Perio
TMJ problems
Endodontically treated teeth
People taking bisohosphonates

Mehta et al 2011

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2
Q

What should be made before managing generalised tooth wear?

A

Mounted study casts in CR with a wax up

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3
Q

What are the disadvantages of direct composites in wear cases?

A 
Polymerisation shrinkage 
Bulk fracture 
Discolouration 
Need good isolation 
Need good quality enamel and dentine to bond to
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4
Q

What percentage of teeth become non vital once prepared for full coverage crowns? Reference

A

Saunders 1998

19%

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5
Q

What is the effect of asthmatic inhalers on tooth surface loss? Reference

A

Mehta et al 2011

Can be very acidic pH4.31

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6
Q

What is the 10 years survival rate for direct vs indirect composites? Reference

A

Mehta et al 2011
Direct 62%
Indirect 75%

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7
Q

What is the normal amount of enamel loss per year? Reference

A

Lambretchs et al 1989

20-38microns

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8
Q

What happens when tooth wear happens very fast?

A

There is no or little dento alveolar compensation

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9
Q

What are the three main treatment options for tooth wear?

A

Conventional fixed restorations
Removable onlay/overlay prosthesis
Minimal prep adhesive

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10
Q

What is the survival rate for cast metal overlays? Reference

A

Channa et al 2000

90% 5 yr

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11
Q

What is perimolysis ?

A

Mehta et al 2011

Erosion of the palatial surfaces of the maxillary anterior teeth

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12
Q

How successful is the Dahl approach? Reference

A

Poyser et al 2005

94-100%

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13
Q

What percentage of the population suffer from wear and what percentage is pathological?

A

Smith and Robb 1996

98%
10%

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14
Q

What is the success rate for indirect composite resins? Reference

A

96% Mehta et al 2011

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15
Q

Which teeth should be sensibility testes in cases of wear? Reference

A

Mehta et al 2011

All teeth that have been severely affected

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16
Q

Which groups of drugs can cause xerostomia ?

A

Antidepressants and diuretic s

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17
Q

How can anterior maxillary tooth wear be classified? Reference

A

Chu et al 2002
Palatial surfaces only
Palatial and incisal surfaces
Labial surfaces only

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18
Q

What are the advantages of using cast adhesive alloys?

A

Can be fabricated in thin sections
Minimal wear of the antagonist tooth
Protects residual tooth
Places supra gingival

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19
Q

How should tooth wear be subclassified ?

A

Localised or generalised
Maxillary or mandibular
Ant vs post

20
Q

What preventative advice can be given to someone suffering from tooth wear?

A 
Fluoride application
Desensitising toothpaste
Diet modification
Habit changes
Splints 
Referral to GM
21
Q

Tooth surface loss encompasses which components?

A

Erosion
Abrasion
Attrition
Abfraction

22
Q

Who came up with the term TSL?

A

Eccles 1982

23
Q

What percentage of people with GORD are symptomatic? Reference

A

Bartlett 1996

32%

24
Q

Why does dento alveolar compensation occur in people with tooth wear?

A

To preserve masticatory efficiency

25
Q

What is the Dahl theory?

A

Relative axial tooth movement resulting from localised restorations are placed in supraocclusion. Occlusion then re-establishes

1975

26
Q

What can you use as Dahl appliances on anterior teeth?

A

Palatal veneers
Composite buildups
Crowns

27
Q

What are the indications for restoring teeth where TSL has occurred?

A

When it begins to interfere with everyday life
Normal function disrupted me risk of pupal necrosis
Appearance unacceptable
Progressive wear

28
Q

Which recreational drugs are associated with erosive tooth wear?

A

LSD and ecstasy

29
Q

Which common supplements could be associated with erosion?

A

Iron formula and vitamin C

30
Q

What are the options for patients with localised anterior tooth wear with inadequate space?

A

Conventional crowns
Reorganise the occlusion and out the patient into CR to create space
Dahl appliance

31
Q

Which index can be used to classify tooth wear?

A

Smith and knight classification

Basic erosive wear exam

32
Q

What is tooth wear?

A

Pathological loss of dentine and enamel which is not due to carious process mainly seen in Saudi, Eskimo and Australian Aboriginals

33
Q

What is attrition?

A

Tooth loses caused by tooth to tooth action which can be issues by parafunctional activity or due to rough unglazed ceramic surfaces

34
Q

What is abrasion?

A

Wear of tooth structure due to an extrinsic course eg over zealous brushing, toothpaste, fibrous diet

35
Q

Erosion is caused by?

A

Non bacteria acid attack on teeth

Intrinsic vs extrinsic
Intrinsic: stomach ulcers, hiatus hernia, dyspepsia, pregnancy, obesity, anorexia, bulimia, GORD
Extrinsic: diet: Vit C, carbonated drinks, asthma pumps, profession: battery acid and swimmers

36
Q

What can aggravate attrition?

A

Lack of posterior support

37
Q

What is the process to build ups direct ?

A
  1. Wax up
  2. Putty template or suck down splint
  3. PTFE on adjacent tooth to prevent sticking of composte
  4. Apply lingual enamel and should be 1.5mm short of incisor edge using stent
  5. Then dentine shade
  6. Then incisal edge using stent
  7. From distal incisal edges
  8. Forms mesial incisal edge
  9. Polishing
38
Q

What is Abfraction?

A

Progressive loss of hard tissues due to biomechanical loading forces

39
Q

T/F tooth wear is complex?

40
Q

What are are the intrinsic sources of acid?

A

GORD
Vomiting
Ruminatin

41
Q

What are the extrinsic sources of acid?

A 
Envirinemt 
Diet
Lifestyle 
Exercise
Medication
42
Q

What are the causes of GORD?

A
  1. Sphincter incompetence: hiatus hernia, diet, pregnant, neuromuscular
  2. Incresed gastric pressure : obesity, as cites, pregnant
  3. Increased gastric volume : meals,obstruction, spasms
43
Q

What are thr causes of vomiting?

A

Psychosomatic :stress eating disorders
Metabooc and endocrine: diabetes, pregnancy, uraemia
Gastro intestinal disorders: peptic ulcer, obstruction, nervous system disorders, cerebral palsy
Drug induces: NSAIDS, aspirin, cytotoxic, alcohol

44
Q

How do you mange tooth wear?

KING

A

Assess the rate

General prevention

45
Q

How can you assess the rate of tooth wear!

KING

A 
Tooth wear index
Linear and 3D direct measurement
Sergial study models
Tooth index
Photos
46
Q

How do you prevent tooth wear?

KING

A 
Management GORD
Dietary counselling 
Lifestyle counselling
Desensitisation 
Splint
47
Q

What dietary counselling can you give ?KING

A 
Reduce frequent of acidic food and drink
Limit to meal time 
Avoid sipping habits
Check pH of mouth wash and medication 
Chew gum 
Consider finish meals with alkaline foods eg milk or cheese
Use antacid
48
Q

What can you use for desensitisation therapy?

A 
Fluoride toothpaste
Sugar free gum
Low abrasive toothpaste
Dentine binding agents
Occlusal guard
Endo

Restorative (45 decks)

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