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
what are signs of unknown aetiology? and what to do?
- Often unusual wear pattern
- Patient may know aetiology but will not tell you
- Plan warily
- Communicate a guarded prognosis because if haven’t fixed aetiological problem failure will result for restoration
what exam related to aertiology?
Comprehensive
Use of indices?
Try relate findings to aetiology
Remember tooth wear patients have caries & perio disease
need to find out aetiology and control before definitive plan
what are common preventative advice?
Fluoride:
High dose toothpaste
Alcohol free mouthwash
Dietary modification:
Frequency & quantity
Method of delivery
Elimination & addition
Remineralization:
Tooth Mousse
Sugar free gum
interventions to control aetiology?
- Toothbrushing instruction
- Splint therapy
- Signposting:
CBT
Hypnotherapy - Referral:
GMP
Psychiatrist
Social services
