tooth wear part 2 patterson Flashcards
main aetiology for toothwear
- Attrition
- Erosion
- Abrasion
- Combination
- Unknown
why is aetiology of how they got toothwear important?
- Attempt to reduce further wear
- Plan for problems, contingencies & failure
- Allow you to be realistic with yourself & patient
- Identifies wider medical & wellbeing issues & allows signposting
- Prognostic indicator
- Enhances consent process
- Aids clinical diagnosis & treatment planning
what are modifying factors for attrition?
- Lack of posterior teeth (wear on remaining teeth is higher)
- Occlusion
- Restorations (eg porcelain abrasive to teeth)
- Erosion & Abrasion
- Stress & Anxiety
common features seen in a bruxist?
- Significant wear throughout dentition
- Repeated restoration failure
- Root fractures
- Often onset in early adulthood
- Progressive
cause of this wear?
physiological wear you seen given age of patient being old
- not worrying
common features for lack of posterior support wear?
- Wear is more extensive as no posterior support
- Often more rapidly progressive as no posterior support
- fix by making dentures to protect anterior dentition
common features of wear due to occlusion?
- lot of wear caused by occlusion compounded by parafunction (clenching or bruxism)
- Deep overbite – lower incisors (wear seen)
- Edge to edge occlusion (can be posterior open bite) – localised wear
common features of wear due to restortions?
- wear worse than expected as teeth opposed to restoration tends to be porcelain (abrasive)
what are these evidence of?
parafunction
- multiple cusp fracture
- multiple cracks in restoration
- root fractures in unrestored teeth
types of extrinsic and intrinsic erosion types and some modifying factors? what is worse?
extrinsic
- fizzy drinks or sweets
- drugs
intrinsic
- eating disorders
- reflux or other med conditions
modifying factors
- lifestyle
- psychology therapy
intrinsic is worse harder to modify
common features seen in carbonated drink wear?
- Incisal erosion on upper centrals
- Cupping on lower molars
- Palatal erosion on upper incisors
- Sensitivity
- Interproximal caries and buccal white spot/brown spot caries
common features of eating disorder?
- Palatal erosion on upper teeth
- Polished restorations
- Erosion around restorations
- Sensitivity
- Caries
- Altered taste – sometimes
- Halitosis – sometimes
- Soft tissue changes (bulimia) - rarely (putting fingers down their throat)
what are abrasive behaviours?
- toothbrushing
- occupational
- habits
easy to modify if listen to advice and modify behaviour
toothbrush abrasion issues to consider?
- Localised or Generalized
- Frequency & duration
- Bristle & toothpaste abrasiveness
- Brushing technique instruction
- Electric v manual
- Part of a combination wear problem eg Eating disorder?
- Part of a stress/anxiety related problem?
common aetiology combinations?
- 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
rate of progression can go up massively
