Tooth wear part 2 Flashcards by Alistair Stoddart

What is the possible aetiologys of tooth wear

Attrition

Erosion

Abrasion

Combination of these

Unknown

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What is the importance of finding the aetiology of tooth wear

Attempt to reduce further wear

Plan for problems, contingencies and failure

Allows you to be realistic with Pt and yoursef

Could help identify any wider medical and well being issues and allows signposting

Prognostic indicator

Enhances consent processs

Aids in clinical daignosis and Tx plan

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Within the spectrum of Attrition what are the 2 causes either end of the spectrum

Physiological wear (age)

Bruxist

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What are the modifying factors that affect attrition

Lack of posterior teeth/support

Occlusion

Restorations

Erosion & Abrasion

Stress & Anxiety

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What are the common features of a Bruxist

Significant wear throughout dentition

Repeated restoration failure

Root fractures

Often onset in early adulthood

Progressive wear that can be rapid

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What is a lot of tooth wear caused by and often compounded with

Nature of occlusion often compunded by parafunction

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In a deep overbite where would wear be found

Lower incisors

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In edge to edge occlusion where is wear often found

Localised wear

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What common resoration material has increased likelyhood of tooth wear to opposite teeth

Unpolished or unglazed porcelain

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What are potential signs of parafunction WITHOUT any obvious tooth wear

Multiple cusp fracture

Multiple cracks around restorations

Root fractures in unrestored teeth

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What are extrinsic causes of Erosion

Carbonated drinks

sports drinks

Alcoholic acidic drinks

Citrus drinks

Acidic drinks and sweets

Pickles

Drugs

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What are intrinsic cause sof erosion

Eating disorders

GORD

Uncontrolled diabetes

Other medical causes

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What are the modifying factors to erosion

Lifestyle

Amount & frequency

Level of control

Psychosocial, stress e.t.c

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What are common features of excessive carbonated drink intake

Incisal erosion of upper centrals

Cupping on lower molars

palatal erosion on upper incisors

Palatal erosion on upper incisors

Sensitivity

IP caries and buccal white/brown spot caries

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What are common dental features of a eating disorder

Palatal erosion on upper teeth

Polishes resorations

Erosion around restorations

Sensitivity

Caries

Altered taste

Halitosis

Soft tissue changes in bulimia

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What behaviours can lead to abrasion

Toothbrush abrasion

Oral self harm

Tongue studs

Occupational types

Unusual habits

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If a Pt presents with toothbrush abrasion what issues is there to consider

Is it localised or generalised

Frequency and duration of brushing

Bristle and toothpaste abrasiveness

Brushing technique

Electric or manual

Part of a combination wear problem e.g. with a eating disorder

Part of a stress/anxiety problem

What are common combinations of tooth wear and what can the reasons be

Erosion (Intrinsic & Extrinsic); Attrition; Abrasion

-Alcoholism & Drug abuse
-Eating disorder

Erosion (Extrinsic) & Attrition

-Bruxist with poor diet

Erosion (Intrinsic & Extrinsic) & Attrition

-Bruxist with poor diet & GORD

How would you find the aetiology of tooth wear

Comprehensive examination

Use of indices

Try relate findings to aetiology

What is common preventitive advice for tooth wear

Fluoride:
-High dose toothpaste
-Alcohol free mouthwash

Dietary modification:
-Frequency & quantity
-Method of delivery
-Elimination & addition

Remineralization:
-Tooth Mousse
-Sugar free gum

What interventions is there to control aetiology

Toothbrush instruction

Splint therapy

Signposting
-CBT
-Hypnotherapy

Referral

Why would a Pt have a lack of posterior support

Denture intolerance

Denture refusal

Supervised neglect

What is a key principle with dentures and tooth wear Pt’s and why

Try and avoid complete dentures

Bruxism doesnt stop so will just lead to fractured dentures, ridge resorption, pain and ulceration under denture

What removeable prosthodontics is involved in Pt with tooth wear

Overdentures

Transitional dentures

Metal based dentures

Simplifying Small saddles

What does rehabilitation involve in removeable pros and tooth wear

Increase in the vertical dimension of occlusion

What is an overdenture

Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants

What other terms may a overdenture be called

Overlay denture or Overlay prosthesis

What are the dvantages of overdentures

Correction of occlusion and easthetics Support Toth wear management Presservation of ridge form proprioception Denture retention Can be used with precision attachments MRONJ & radiotherapy patients – avoids extractions Psychological benefits Useful in elderly patients Eases transition to edentulism

What are the disadvantages of overdentures

Need for good oral health as they are made of tooth so if they dont they will fail Increased caries/perio problems Care homes Denture fracture Discomfort/infection Medical hisotry Potentially more traumatic extractions

What care is needed for overdentures

Good OH Fluoride toothpaste application to roots Regular examinations and radiographs Denture hygiene

What are transitional dentures used for

If a pt has complete occlusal collapse and cant tolerate posterior support so these are made to see if First can they deal with the dentures and then dentures with an increased OVD to create space for restorations

How do transitional dentures work

Let pt wear them for a few months and see if they cope with dentures and increased OVD If they you can move onto a more definitive Tx plan

When is the OVd increased with transitional dentures

Increased from n o denture to transitional BUT NO CHANGE between transitional and definitive

If metal based dentures are being used in a tooth wear case what must you do before making it

Need to have a wax trial of teeth before making Co/Cr

What is Co/Cr in a complete denture not good at

Getting a peripheral seal

How do you fix Co/Cr not giving a good peripheral seal in a complete denture

Make an acryclic post dam An attempt to make a complete denture both retentive & indestructible

How could you simplify small saddles on a denture

Bridgework

What is a key principle about occlusion in dentistry

Where possible try to conform to exsisting occlusion

When would you conform to exsisting occlusion

Works bests in stable occlusion with sufficent index teeth, ensuring the prosthesis/restoration doesnt alter occlusion

When would you change/rehabilitate the occlusion

This often happens in tooth wear Often occlusion is unstable and lack of sufficient index teeth Usually more challenging to record occlusion Decision on how much to increase OVD

What do you do in tooth wear rehabilitation

Impressions & facebow Mounted articulated casts on semi-adjustable articulator +/– surveying High quality Interocclusal record – with & without increasing the OVD Diagnostic wax up(s) Stents – mock-up – temporaries (if indirect); for build-ups; aids consent use something like protemp to show pt Temporary (transitional) dentures Clinical photographs (Radiographs)