Toothwear 1 Flashcards

1
Q

Types of toothwear?

A

Physiological - normal wear associated with age

Pathological - wear exceeds what
would be seen as normal for the age.

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2
Q

Define attrition

A

Physiological wearing away of tooth structure, due to tooth to tooth contact.

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3
Q

Where may attrition be found? What are typical presentations?

A

Occlusal and incisal contacting surfaces

Reduction in cusp heigh and flattening of inclined planes

Shortening of crown length.

Almost always related to parafunctional habit

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4
Q

What is abrasion?

A

Physical wear through abnormal mechanical processes, irrespective of occlusion. Involves foreign object or substance repeatedly contacting tooth.

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5
Q

Common presentations for abrasion?

A

Site / pattern related to abrasive element

Often buccal or incisal or cervical on canine or premolars

Most common cause is aggressive tooth brushing

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6
Q

Define erosion

A

Loss of tooth surface due to chemical process that does not involve bacterial action

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7
Q

Typical presentations of erosion?

A

Chronic exposure to acidic substances

Early stages, enamel is affected and loss of surface detail

Eventually surfaces become concave, smooth and eroded

Typically bilateral, concave lesions

Increased translucency of incisal edges

No staining

Restorations sit proud of teeth

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8
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 tooth

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9
Q

What occurs during abfraction? Typical presentation?

A

Tooth loss at cervical margin

Loading forces on occlusal surface cause flexural stress and failure of enamel and dentine at a location away from the loading

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10
Q

What are the main things an assessment of toothwear needs to do?

A

Recognise problem

Grade it’s severity

Diagnose likely cause or causes

Monitor progression
- active or historic
- preventative measures working?

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11
Q

What MH may mean erosion is involved?

A

Bulimia

Alcoholism

Eating disorders

Low pH medication

Heartburn and GORD

Pregnancy

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12
Q

What things about a patients history should we know for toothwear

A

Chief complaint

Medical history and meds

Regular attender who will comply with treatment?
- OH habits
- brushing regime

Social
- smoking, drinking
- bruxism
- habits such as fingernail biting
- sports

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13
Q

What should be checked in an EO exam for toothwear?

A

TMJ for restriction of movement

Musculature, for hypertrophy

Mouth opening, for restriction or deviation on movement

Overclosure

Lip line and smile line

FWS, OVD and RFH

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14
Q

What IO examinations should be checked for tooth wear?

A

Occlusion

Overbite and overjet

Assess contacts, are they stable

Assess tooth movements when jaw moves

Soft tissues, keratosis from parafunction?

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15
Q

When examining tooth wear specifically, what should be recorded?

A

Location of wear
- anterior / posterior
- localised / generalised

Severity
- enamel only
- into dentine
- severe

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16
Q

What is the BEWE?

A
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17
Q

immediate treatment for toothwear?

A

Deal with pain

Sensitivity - de sensitising agents

Pulp extirpation if pulp health compromised

Smooth sharp edges - if causing trauma

Extraction - pain in unrestoreable teeth

TMJ pain - needs to be controlled, especially in attrition

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18
Q

Initial treatment, after immediate, for toothwear

A

Stabilise dentition

Deal with caries

Deal with perio

Deal with Oro-mucosal

Wear is important but whole mouth essential

Then finally develop a preventative programme of treatment, as no point treating an ongoing problem

19
Q

What preventative treatment might be done?

A

Monitoring of wear

Baseline wear recording required
- bewe
- photographs

  • will identify if it is historic or active
20
Q

How might one prevent abrasion?

A

Remove ‘foreign object’

Change toothpaste

Alter brushing habits

Change habits such as nail biting, wire stripping, pen chewing etc

Place RMGIC or GIC in cervical abrasion due to tooth brushing etc

21
Q

Why is RMGIC first line cervical restoration material?

A

Best survival rate

Fluoride release

Composite had higher modulus compromising retention

Balance aesthetics with retention of restoration

22
Q

How is attrition prevented?

A

Parafunction is usually the cause

often a centrally mediated response to life stressors
- CBT
- hypnosis

Can help prevent parafunction

Splints can be used, wear is done to these rather than teeth
- soft splint is a good diagnostic device as it shows where wear facets mainly are. Hard splint is more robust.

23
Q

How might erosion be prevented?

A

Target source of the acid

Use fluorides, such as tooth mousse GC, dural hat varnish, fluoride mouthwash, high fluoride toothpaste etc.

Use desensitising agents for symptomatic relief

Manage diet if consuming high volumes of sugar / high frequency
- use a straw for drinks etc

Medical control of gastric acid - possible consult doctor
- Rennie or omeprazole

24
Q

How might abfraction be prevented?

A

Low modulus restorations in cervical cavities

Assess occlusion, any heavy occlusal contacts

25
Q

Classifications of maxillary anterior toothwear?

A

Limited to palatal surfaces only

Palatal and incisal edges, with reduced crown height

Limited to labial surfaces

26
Q

How actively treat maxillary anterior toothwear limited to palatal surfaces?

A

Tooth coloured restoration material placed palatally

27
Q

Why might OVD be unchanged but teeth be worn?

A

Rapid toothwear with no time for alveolar compensation

Easiest to treat as no change in OVD

28
Q

How might space be created for restoration of tooth wear?

A

DAHL TECHNIQUE

  • removable COCR or composite anterior bite plane

Allows occlusion on raised Cingulum, and disclusion of posterior teeth, leading to increase in OVD

3-6 months, variable length but faster in younger patients. If no movement in 6 months it wont work.

29
Q

When wont DAHL technique work?

A

Active periodontal disease

TMJ issues

Post ortho

Bisphosphonate medication

Dental implants

Existing conventional bridges

30
Q

What clinical feature gives confidence worn anterior teeth can be restored?

A

Remaining enamel ‘ring of confidence’

31
Q

What should not be done when treating lower anteriors for tooth wear? What should be done if building them up?

A

No not increase OVD in lowers

If have to build up, do them first before uppers

32
Q

How can localised posterior tooth wear be treated restoratively?

A

Composite resin to the palatal of the maxillary canines

Puts posterior teeth in disclusion during lateral movements a

Posterior saved from further damage and can be restored

33
Q

What information would i give to a patient before completing diagnostic wax ups?

A

Your front teeth will receive tooth coloured fillings to cover the exposed and worn tooth surface

This will prevent them from wearing more, this is the reason it needs treating

Procedure carried out without local anaesthetic, minimal to no drilling to teeth

We add to teeth, not remove

Improved aesthetics

Your bite may feel strange at first as only front teeth with contact, may have trouble chewing

This will change as your back teeth gradually come back together in 3-6 months

May lisp at first and may bite lips and tongue initially but this will all resolve

If you have crowns or bridges or RPDs at the back, they will likely need replacing

34
Q

What information can i give regarding longevity of tooth wear restorations?

A

Should be good, small potential for deboning though

But these can be replaced easily with no damage to tooth

Will require maintenance with some polishing, occasional chipping may occur

35
Q

What 3 categories of generalised wear are there?

A

Excessive wear with loss of OVD

Excessive wear without loss of OVD but available space

Excessive wear without loss of OVD and with no space

36
Q

What is crown lengthening surgery? Pros cons?

A

Crown lengthening by lowering gingiva and adjusting crowns

Can improve aesthetics and make space in OVD

Often post op sensitivity
Black triangles due to papilla change
Greater chance of pulpal damage

37
Q

How must i cover myself when treating a patient with toothwear?

A

NOTES

  • wear recognised
  • patient informed of wear
  • monitoring
  • advice given
  • patient compliant / non complaint our unwilling to follow course of action
  • surface treatments e.g. topical fluoride noted at each occasion
  • consent gained for treatment
  • pt must understand their role in this
  • all discussions recorded properly
  • record rationale behind preventative treatment or temporary treatment, and pt must understand this
  • minimally invasive treatments done first
  • second opinion from specialist in tough cases
  • referral documentation kept
38
Q

How treat toothwear with space present?

A

Direct or indirect composite

Porcelain veneers

Onlays

Adhesive dentistry

39
Q

How treat localised maxillary anterior tooth wear with little / no space?

A

Gain space with DAHL appliance

Restore with composites, veneers, crowns etc
Over-dentures

40
Q

How treat localised mandibular anterior toothwear with little to no space?

A

Monitor of only lower anteriors

If both, gain space with DAHL then restore lowers before uppers

41
Q

How treat localised posterior tooth wear with little to no space available?

A

Accept and monitor

Provide canine rise if posterior disclusion absent on lateral / Protrusive movement

42
Q

How treat generalised toothwear with increased FWS

A

Overclosed because wear uncompensated

Work to existing RFH

43
Q

How treat generalised toothwear with normal FWS?

A

Compensation occured

Increase OVD and check tolerance to new OVD

If tolerated then treatment plan for full mouth, if not

Consider crown lengthening

44
Q
A