Tooth wear and erosion

Question 1

Define tooth wear and dental erosion

Answer 1

• Tooth wear: term used to describe the surface loss of dental hard tissue from causes other than caries, trauma or as a result of developmental disorders”
• Dental erosion: Loss of hard tissue from the tooth surface by chemical means. The agent can be intrinsic or extrinsic

Question 2

Understand that the causes behind tooth wear can be multifactorial

Answer 2

• Attrition: toothwear caused bytooth-to-toothcontact, resulting in loss oftoothtissue, usually starting at the incisal or occlusal surfaces
• Erosion: the loss of tooth surface through chemical processes
• Abrasion: progressive loss of hardtoothsubstances caused by mechanical actions other than mastication ortooth-totoothcontacts
• Abfraction: the loss of hard tissues from eccentric occlusal loads leading tensile stresses on the cervical area of the toot

Question 3

Identify and describe the clinical signs and symptoms of tooth wear and dental erosion

Answer 3

• Smooth satin appearance (bruxism produces very reflective highly polished flat facets)
• Absence of developmental ridges (Perikymata)
• Rounded teeth
• Increased translucency of incisal edge (may appear dark)
• Cupping or grooving of teeth - concave loss of tooth tissue
• Restorations seem separate of tooth tissue
• No staining of teeth

Question 4

Identify the possible extrinsic causes of tooth wear and dental erosion

Answer 4

Environmental
• Battery factory workers
• Gas chlorinated pools
• Professional wine tasters

Lifestyle
• Unusual habits
• Ecstasy usage

Medications
• Suspensions
• Aspirin and Vitamin C
• Asthma medications

Dietary factors
• Acidic foods and drinks (they have pH of 2.1 - 4.6)

Question 5

Identify the possible intrinsic causes of tooth wear and dental erosion

Answer 5

• Vomiting and eating disorders
• Gastro-oesophageal reflux disease (GORD)
• Regurgitation and Gastro-intestinal Reflux (GIR)
• Rumination (regurgitation and re-chewing)

Question 6

Identify the risk factors and consequences of dental erosion

Answer 6

• Reflux disease
• Bulimia: self induced vomiting
• Soft drinks (low pH) and causes burping and gastro- oesophageal reflux disease if drinking before bed
• Obesity leads to gastro- oesophageal disease and erosion of teeth
• Asthma: Ventolin meds have very low pH and, asthma meds can make the oesophageal sphincter more relaxed = reflux disease
• Saliva hypofunction: dehydration/ caffeine addiction or medications like anticholinergics

Question 7

Describe how you would record notes on an ‘at risk’ patient and how you would manage them

Answer 7

Management:
• Examine patients with tooth wear and grade the severity

• Record it: intra oral photos, note size and places of lesions, tooth wear monitoring and tooth index
• Determine causative factors: medical history (reflux disease, medicines), diet, saliva testing (amount, buffering capacity), time/ method of consuming acidic beverages
• Prevention of tooth wear: educating patients about causes and consequences, provide fluoride, high fluoride toothpastes, tooth mouse, chewing gum, sodium bicarbonate mouthwash, diet counselling (drink during meals, eat cheese at the end of a meal, do not brush after eating), sealants, restorations, referrals to medical practitioners
• Monitoring: 6- 12 monthly comparisons to previous moulds, radiographs, intraoral pictures

Question 8

List the levels of the Smith and Knight tooth wear index

Answer 8

0: no loss of enamel
1: loss of enamel but minimal loss of contour cervically
2: exposed dentine
3: exposure of pulp or secondary dentine
4: complete loss of enamel with pulp exposure

Question 9

List the goals of restoring tooth wear and dental erosions

Answer 9

• Restore function and Oral Vertical Dimension (OVD)
• Maintain pulp vitality
• Reduce sensitivity
• Aesthetics

Question 10

Explain the definitive management of erosion lesions with respect to the primary dentitions

Answer 10

Anterior teeth:
• Difficult because non retentive
○ GIC
○ Strip crowns 
○ Composite  usually performed by a  specialist

Posterior teeth
○ Stainless Steel Crowns (SSC’s) (Hall technique)
○ GIC
○ Composite

Question 11

Explain the definitive management of erosion lesions with respect to the permanent dentitions

Answer 11

• GIC

Definitive restorations
• Composite- direct or indirect
• Porcelain
• Veneers
• Cast metal restorations