tooth wear Flashcards
the aetiology and clinical presentations of toothwear/ non carious tooth tissue loss the diagnosis of early management of patient with toothwear with a focus on prevention and management
what is tooth loss also known as
non carious tooth tissue loss( NCTTL)
what does NCTTL stand for
no carious tooth tissue loss
is tooth loss normal
occurs in life normally
when is tooth loss pathological
when rate of loss or degree of destruction is excessive
what can tooth loss lead to
aesthetics
sensitivity
function
what is toothwear due to
a non carious process
which processes are included in toothwear
attrition
abrasion
erosion
what is toothwear described by
aetiology
distribution localised or generalised
severity
which population is erosion increased in
youths
which material used for crowns could cause tooth surface loss
porcelain
what percentage of 5 year olds have TSL
33%
which surfaces do 5 year olds have TSL ON
buccal surfaces of primary incisors
what percentage of 5 year old children have TSL which extends into the dentine or pulp
4%
what percentage of 5 year olds have TSL on the lingual surfaces
57%
how much percentage of 5 year olds have TSL loss in the dentine and pulp
16%
what is the pathological loss of tooth tissue
erosion
attrition
abrasion
what is erosion
irreversible progressive loss of dental hard tissue caused by an acidic chemical process not caused by bacteria
what is attrition
the loss of tooth surface or a restoration caused by tooth-tooth contact
remember by the two tt in attrition
what was the percentage of moderate tooth wear in 1998
11%
what was the percentage of moderate tooth wear in 2009
15%
what is the definition of abrasion
the abnormal wearing away of a tooth surface substance or a restoration by a mechanical process other than tooth contact
what do teeth clinically look like when suffering from erosion
shiny
cupping in the teeth- eg post teeth or palatally
proud restorations
how is erosion classified
by source of acid extrinsic or intrinsic
what is intrinsic acid
acid coming up
bulimia
stomach acid-GORD( gastro oesophageal reflux disease)
what is extrinsic acid
acid going in
ef citrus fruit
juices
white wine worse than red
what do we need to ask in regard to bulimia
past or present history of being bulimic
what are the four things needed for erosion
tooth surface
time
extrinsic
host
what might delay erosion
fluoride
why might GORD occur
sphincter incompetence
increased gastric pressure
increased gastric volume
why might vomiting occur
psychosomatic metabolic/endocrine drug induced alcoholism GI disorders
what is ruminant eating
chew and then bring it up and chew it more
what are the symptoms of GORD
HEARTBURN retostenral discomfort epigastric pain dysphagia chronic cough sore throat hoarseness sour taste at the back of the throat
describe anorexia nervosa
aversion to food
restricting and purging types
what is the incidence if anorexia nervosa
7/100000
how many new cases of anorexia are found per year
4000
what is the prevalence of anorexia
0.5-1%
what is the F:M ratio of anorexia
10:1
what is the average age presentation
16
what is bulimia
overeating followed by purging
what is the insidence rate of bulimia
8.6-14 per 100000
what percentage of people got bulimia in USA in 18-30 years
1-4%
what is the female to male ratio of bulimia
10:1
what weight are bulimics usually
10% normal body weight to very obese
what affects dietary erosion
amount
frequency
method of consumption
timing of consumption
what are predisposing factors
saliva flow ph buffering presence of salivary mucins clearance rates from from different oral sites
what is the clinical presentation of erosion
anterior teeth- loss of surface anatomy smooth enamel surface chipping of incisor edges palatal hollows areas where enamel is absent exposure of pulp if intrinsic- palatal surface if extrinsic- labial
what does erosion look like on posterior teeth
loss of surface anatomy cusp cupping proud restorations darkening of colour pupal exposure
how does caries and erosion differ
loss of the organic matrix in erosion
what is the clinical presentation of attrition
enamel and dentine wearing away at the same rate
localised facets, flattened cups and incisal edges
worn surfaces
shiny amalgam in areas of contact
possibly massetric hypertrophy
possibly fractured cusps or restorations
increased risk of tooth motility
slow process as secondary dentine is laid down
what is bruxism
common parafunctional activity in response to stress
associated tongue scalloping and cheek ridging
masseteric hypertrophy
what is abfraction
supposes that occlusal forces cause compressive and tensile strength which are concentrated on the cervical regions of the tooth and cause micro-fracture of cervical enamel rods
what is the clinical look of abfraction
deep v shaped notch
may be single tooth affected
toothbrush unable to contact base of defects
defects may be sub gingival
clinical consequences of NCTTL
change in appearance
apin or sensitivity
loss of OVD
functional difficulties
what is OVD
occlusal vertical dimension
what is the initial management of tooth wear
identify presence and severity
identify aetiology
monitoring
prevention
what is the issues with the severely worn dentition difficulties
lack of tooth tissue plural problems aesthetic compromise soft tissue changes occlusal changes lack of space for restoration habitual/ aetiological factors
what might aetiological factors cause
damage to restoration
further wear of teeth
how do we see if the toothwear is progressing
sensitivity and staining
monitoring
what can we use for monitoring
study models silicone index clinical photographs description measurement: crown indicies ginigval margin
what is the management of NCTTL
identify cause and assess long term prognosis
institute preventative measures to reduce TSL
monitor
operative treatment
Review
prevention of alcohol
don’t get them to brush after they’ve eaten
diet advice
control of GORD- liase with the GP
water and sodium bicarb mouthwash
what can we use to desensitise and strengthen the teeth
fluoride mouthwash and varnish fluoride paste-Gelkam low abrasive toothpaste sugar free gum dentine bonding agent tooth mousse anti erosion toothpaste
what can splints be used for
bruxism hard or soft splints prevention of wear creating of space assessing tolerance of raising OVD mandibular dysfunctions protection of new restorations
where is a soft splint used
on lower teeth
how do we prevent abrasion
low abrasive toothpaste brushing technique patient habits brushing force bristle stiffness frequency abrasive restorations
