Tooth wear part 2 Flashcards
What is the possible aetiologys of tooth wear
Attrition
Erosion
Abrasion
Combination of these
Unknown
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
Within the spectrum of Attrition what are the 2 causes either end of the spectrum
Physiological wear (age)
Bruxist
What are the modifying factors that affect attrition
Lack of posterior teeth/support
Occlusion
Restorations
Erosion & Abrasion
Stress & Anxiety
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
What is a lot of tooth wear caused by and often compounded with
Nature of occlusion often compunded by parafunction
In a deep overbite where would wear be found
Lower incisors
In edge to edge occlusion where is wear often found
Localised wear
What common resoration material has increased likelyhood of tooth wear to opposite teeth
Unpolished or unglazed porcelain
What are potential signs of parafunction WITHOUT any obvious tooth wear
Multiple cusp fracture
Multiple cracks around restorations
Root fractures in unrestored teeth
What are extrinsic causes of Erosion
Carbonated drinks
sports drinks
Alcoholic acidic drinks
Citrus drinks
Acidic drinks and sweets
Pickles
Drugs
What are intrinsic cause sof erosion
Eating disorders
GORD
Uncontrolled diabetes
Other medical causes
What are the modifying factors to erosion
Lifestyle
Amount & frequency
Level of control
Psychosocial, stress e.t.c
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
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
What behaviours can lead to abrasion
Toothbrush abrasion
Oral self harm
Tongue studs
Occupational types
Unusual habits
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)
