Tooth wear

Question 1

tooth wear is also known as…

Answer 1

non-carious tooth loss, NCTL

–> it is not caused by a carious process

Question 2

tooth wear is a normal, physiological process, when does it become pathological?

Answer 2

when there is EXTREME destruction of hard tooth tissue

Question 3

what are the 3 types of NCTL

Answer 3

erosion (acid chemical process)

attrition (tooth-tooth interaction)

abrasion (same as erosion but caused by MECHANICAL process)

Question 4

define erosion

Answer 4

the irreversible and progressive loss of dental hard tissue caused by ACIDIC CHEMICAL process -not relating to bacteria

can be on labial (extrinsic acid) or palatal surface (intrinsic acid)

Question 5

define attrition

Answer 5

the irreversible and progressive loss of dental hard tissue caused by TOOTH TO TOOTH CONTACT

Question 6

define abrasion

give e.g. of how abrasion may occur

Answer 6

the irreversible and progressive loss of dental hard tissue by a MECHANICAL PROCESS other than tooth contact

(e.g.tooth brush with coarse toothpaste, toothpicks, piercings, restorations like porcelain crowns, biting wires, pen biting)

Question 7

what is the clinical presentation of abrasion

Answer 7

mainly CERVICAL where a notch will appear

Question 8

sources of intrinsic acid that may cause erosion?

Answer 8

1. GORD
2. pregnancy where excessively VOMMITING
3. ruminant eating
4. eating disorders like anorexia nervosa, bulimia nervosa

Question 9

symptoms of GORD (gastro oesophageal reflux)

Answer 9

Symptoms= heartburn, retrosternal discomfort, epigastric pain, dysphagia, chronic cough, sore throat, hoarseness, sour taste at back of throat. BUT in many cases it is ‘silent reflux’ since up to 1/3 of people who have it DON’T KNOW.
- Ask pt. q. like ‘Do you get a lot of heartburn?’ ‘pain under sternum?’

Question 10

sources of extrinsic acid that may cause erosion?

Answer 10

1. diet: soft juices, OH drinks, fresh fruits, yoghurts and sauces, energy/ sports supplements
2. Oral hygiene products like mouthwashes, saliva subsitutes
3. medications that affect saliva quality/ amount (low saliva rate= high risk for erosion) vitamin C, asthma inhalers

Question 11

what is the difference between erosion and caries

Answer 11

in caries= the PLAQUE ACID leads to demineralisation but the organic matrix is NOT effected

in erosion= the INTRINSIC/EXTRINSIC ACID leads to demineralisation AND the loss of the organic matrix

Question 12

attrition is mostly seen in pts. who…

Answer 12

grind their teeth- bruxisms

may see cheek ridging and masseteric hypotrophy

Question 13

what is the theory of abfraction?

Answer 13

occlusal forces cause compressive and tensile stresses which are concentrated at the CERVICAL region of tooth and cause micro-fracture of cervical enamel rods.

—> will see a deep v-shaped notch around the cervical region. only a single tooth may be affected, and you will know it is not due to oothbrush because it cant reach there.

Question 14

what are the clinical consequences of NCTLL?

Answer 14

change in appearance of teeth (loss of crown height, structural integrity may be compromised, aesthteic concern)

pain/ sensitivity

loss of occlusal stability/ OVD (occlusal vertical dimension)

functional difficulties

Question 15

how do you manage NCTLL

Answer 15

• early detection is key for prevention. and pathological tooth wear is often multifactorial.
  1. determine the aetiology- do a diet sheet that includes the weekend, examine the clinical experience
  2. monitor the toothwear via silicone index, clinical photographs, indices, measurement of crown height or gingival margin
  3. if related to medical conditions like GORD/ acid reflux write to GP
  4. give diet advice (wait 1 hr after eating acidic foods to brush teeth). if pt. has attrition may use splints.