Tooth Wear - treatment Flashcards
tooth wear - diagnosis
pattern of tooth wear
localised
generalised
- wear with loss of oVD
- wear without loss of OVD but with space available
- wear without loss of OVD but limited space
dentoalveolar compensation
tooth wear - immediate treatment
deal with pain
sensitivity
- desensitising agent
- fluorides
- onding agents
- GIC coverage of exposed dentine
pulp extirpation
- if wear has compromised pulpal health
smooth sharp edges
- prevents trauma to cheeks and tongue
extraction
- pain from unrestorable/non-functional tooth
TMJ pain
- important in attrition - acute symptoms need to be controlled
tooth wear - initial treatment
stabilise existing dentition
treat caries
treat perio condition
oro-mucosal
once you have a diagnosis and identified primary cause:
- establish preventative regime
treatment without prevention will fail
tooth wear - preventative treatment
when monitoring identify whether wear is progressing or historic
if active and progressive treatment is required
- includes prevention
tooth wear prevention: abrasion
remove foreign object or substance involved
change toothpaste
alter brushing habits
change habits
- nail biting
- wire stripping
- piercing biting
- pen chewing
cervical toothbrush abrasion - preventative treatment
simple RMGIC, GIC or composite placed
- RMGIC proffered as best survival rate
- does not require tooth preparation
- patient wears through restoration rather than teeth
prevention: attrition
more difficult to address
generally related to parafunctional habit
generally centrally mediated response to life stressors
- CBT
- Hypotherapy
splints can be used
- wear away in preference to tooth
- may be habit breaker
- soft splint can be used as diagnostic device
- hard splints more robust and can be used over a longer term
attrition : michigan splint
popular type of hard splint
provides ideeal occlusion with even centric stops
has canine rise which provide discussion in eccentric mandibular movements
- canine guidance
prevention: erosion
treatment of erosion should be considered in all wear cases
treatments include:
fluorides
desensitising agents
- not really preventative but relives symptoms
dietary management
habit changes
- swilling drinks around mouth
- drinking from cans - straw recommended
- sports drinks/gels
medical
- construal gastric acid - GORD, reflux, hiatus hernia
- anorexia and bullimia
may require discussion with patients doctor
- consent must be gained to contact GMP
- change in drugs may not be possible
abfraction - prevention
assess occlusion on teeth with abfraction lesions
fill cavities with low modulus restorative materials
- RMGIC
- flowable composite
passive management
should be the first part of any wear treatment
prevention and monitoring
phase usually lasts for 6 months
many patients - all that is necessary
active management
intervention threshold
simple restorative intervention
- covering exposed dentine
- filling cupped defects in molars or incisors
more extensive restorations nay be required
- if leads to further complications
- aesthetics have gone beyond patient acceptability
treatment of maxillary anterior tooth wear depends on
pattern of anterior maxillary tooth wear
inter-occlusal space
space required for restorations being planned
quality and quantity of remaining tooth structure
- particularly enamel
- aesthetic demands of the patient
pattern of maxillary anterior tooth wear - classification
tooth wear limited ton palatal surfaces only
tooth wear involving palatal and incisal edges with reduced clinical crown height
tooth wear limited to labial surfaces
Active management of maxillary incisal tooth wear where there is adequate inter-occlusal space
if teeth wear rapidly and there is no alveolar compensation
where there is an AOBV
where there is an increased overjet
- available space for restorations with no change in OVD
- unusual cases
