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BDS4 restorative > toothwear 1 > Flashcards

toothwear 1 Flashcards

1
Q

what are causes of tooth surface loss

A
  • caries, trauma, developmental problems, tooth wear
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2
Q

what is the physiological tooth wear

A
  • normal
  • happens to everyone
  • around 20-38µm per annum
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3
Q

what is pathological tooth wear

A
  • occurs if the remaining tooth structure or the plural health is compromised or the rate of tooth wear is in excess of what would be expected for that age
  • it can also be considered pathological if the pt experiences a masticatory or aesthetic deficit
  • happens in excess of what is expected
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4
Q

causes of tooth wear

A
  • attrition
  • abrasion
  • erosion
  • abfraction
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5
Q

what is attiriton

A
  • the physiological wearing away of tooth structure as a result of tooth to tooth contact
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6
Q

where are attractive lesions found

A
  • occlusal and incised contacting surfaces
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7
Q

what is the early appearance of attrition

A
  • polished facet on a cusp or a slight flattening of an incised edge
  • progression leads to a reduction in cusp height and flattening of occlusal inclined planes
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8
Q

what is attrition almost always associated with

A
  • parafunctional habit - bruxism
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9
Q

what is abrasion

A
  • the physical wear of tooth substance through an abnormal mechanical process independent of occlusion
  • it involved a foreign object or substance repeatedly contacting the tooth
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10
Q

where is the most common area for abrasion and what is the cause

A
  • commonest area if labial/buccal, cervical on canine and premolar teeth
  • from toothbrush
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11
Q

what shape are abrasive lesions

A
  • v-shaped or round
  • shape margin at enamel edge where dentine is worn away preferentially
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12
Q

what are other causes of abrasion not toothbrush

A
  • holdings pins/nails in mouth, electrical wire stripping, fishing line, thread, pipe smoking
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13
Q

how can e-cigs cause abrasion

A
  • heavier than pipes and getting bigger
  • acidic liquid in them = so cause erosion too
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14
Q

what is erosion

A
  • the loss of tooth surface by a chemical process that does not involve bacterial action
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15
Q

what is most common cause of tooth wear

A
  • erosion
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16
Q

what causes erosion

A
  • chronic exposure of dental hard tissues to acidic substances which can be extrinsic or intrinsic
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17
Q

what do erosive lesions look like

A
  • early stages enamel surfaces are affected, there is loss of surface detail, surfaces become flat and smooth
  • typically bilateral, concave lesions without chalky appearance of bacterial acid decalcification
  • hollowed out lesions
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18
Q

what is a common sign of erosin

A
  • ‘cupping’
  • preferential wear of dentine leads to cupping of occlusal surfaces of the molars and incase edges
  • because enamel wears less than dentine so then get small indents on occlusal surface
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19
Q

what do pts usually complain about first with erosion

A
  • teeth appearing darker
  • because get increased translucency of incised edges so can appear dark from mouth shining through
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20
Q

how do restorations react with erosion

A
  • tooth dissolves around the restoration and then restoration left standing proud
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21
Q

why do you not see staining in erosive pts

A
  • because any staining there would have been is washed away by the acid
22
Q

what is abfraction

A
  • loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
  • pathological loss of tooth substance at the cervical margin caused by biomechanics loading forces
23
Q

what are the 2 theories of abfraction

A
  • 1 = it is the basic cause of all non-carious cervical lesions
  • 2= multifactorial aetiology, a combination of occlusal stress, abrasion and erosion

(more likely 2)

24
Q

what is the process of abfraction

A
  • when force is applied to the tooth it bends very slightly and get forces at cervical area which causes micro-stresses on this area and if that happens a lot eventually the enamel and dentine start to fracture off
  • disruption of the ordered crystalline structure of the enamel and dentine by cyclic fatigue
25
Q

what do abfraction lesions look like typically

A
  • v-shaped tooth loss where tooth is under tension
  • classically shape rim at the ACJ
  • could argue it is toothbrush abrasion as looks very similar
26
Q

causes of cervical wear

A
  • multifactorial
  • overzealous tooth brushing
  • lesions mainly in premolar and molars one buccal surface = never lingual
  • good OH and this wear pattern go together
  • restorations in this area wear at same rate as the tooth structure
  • likely to be a combination of erosion, abrasion and +/- abfraction
27
Q

what s the most common type of tooth wear in older pts

A
  • physiological
28
Q

which gender has more wear

A
  • males
29
Q

how much has moderate wear increased over last 10 years

A
  • from 11% to 15%
30
Q

what to get from pt main complaint about tooth wear

A
  • aesthetic impairment
  • functional difficulties = masticatory efficiency, biting of tongue or lips etc
  • pain = not common unless rapidly progressing
31
Q

why is pain unlikely in tooth wear cases

A
  • because tooth wear happens slowly and because of that, get a build up of secondary dentine protecting the pulp
  • so pulp doesn’t come to surface as you wear away teeth, it tends to recede away down the tooth
32
Q

what do you want to know about pts medical history fir wear

A
  • medication causing dry mouth
  • medication with low pH
  • eating disorders
  • alcoholism
  • heart burn
  • GORD
  • hiatus hernia
  • rumination
  • pregnancy = transient problems, goes away after pregnancy when baby not pushing against stomach and cause reflux
33
Q

what social factors are good to know from pts in wear cases

A
  • lifestyle stresses
  • parafuncitonal habits
  • alcohol consumption
  • dietary analysis
  • habits = pipe smoking
  • sports = gels for runners high in acid, grind teeth weightlifting etc
34
Q

extra-oral exam for tooth wear

A
  • must examine TMJ for restriction of movement, clicking, crepitus
  • examine musculature for hypertrophy
  • examine mouth opening for restriction and deviation during movement
  • lip line
  • smile line
  • occlusion = record OVD and RFH
35
Q

why do you need to record occlusion for tooth wear

A
  • often it is normal because tooth wear happens so slowly so OVD/RFH moves with the tooth wear
  • get alveolar compensation
  • but if tooth wear has happened radpily, then will have a decrease in OVD as not able to keep up
36
Q

what is alveolar compensation

A
  • as teeth wear, the bone holding the teeth goes down and the incised level stays the same
  • so teeth get shorter but distance from nose to incised level stays the same
37
Q

what are the two most common wear indices

A
  • Smith and Knight = not so much now
  • BEWE
38
Q

how many grades are there in Smith and Knight indice

A
  • 0-4
39
Q

what is grade 0 for smith and knight

A
  • no loss of enamel surface characteristics
40
Q

what is grade 1 smith and knight

A
  • loss of surface enamel characteristics
41
Q

what is grade 2 smith and knight

A
  • buccal, lingual and occlusal loss of enamel, exposing dentine for less than one third of the surface
  • incisal loss of enamel
  • minimal dentine exposure
42
Q

what is grade 3 smith and knight

A
  • buccal, lingual and occlusal loss of enamel, exposing dentine for more than one third of the surface
  • incisa loss of enamel
  • substantial dentine exposure
43
Q

what is grade 4 smith and knight

A
  • buccal, lingual and occlusal complete loss of enamel, pulpal exposure or exposure of secondary dentine
  • incised pulp exposure or exposure of secondary dentine
44
Q

how does the BEWE indice work

A
  • gives wear a score and a risk level
  • was an attempt to simplify the wear measurement
  • like a BPE for tooth wear
  • easier to do and less open to being subjective
  • give each sextant a score
45
Q

how many BEWE scores are there

A
  • 0-3
46
Q

what is a BEWE score 0

A
  • no erosive wear
47
Q

what is a BEWE score 1

A
  • initial loss of surface texture
48
Q

what is a BEWE score 2

A
  • distinct defect; hard tissue loss <50% of surface
49
Q

what is a BEWE score 3

A
  • hard tissue loss >50% of the surface area
50
Q

what are the risk levels of BEWE

A
  • none= cumulative score of all sextants ≤2
  • low = cumulative score of all sextants 3-8
  • medium = cumulative score of all sextants 9-13
  • high = cumulative score of sextants ≥14
51
Q

what special tests are needed for tooth wear

A
  • sensibility testing
  • radiographs
  • articulated study models
  • intra-oral photographs
  • salivary analysis
  • diagnostic wax-ups
  • dietary analysis

BDS4 restorative (4 decks)

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