Toothwear 1 Flashcards
Types of toothwear?
Physiological - normal wear associated with age
Pathological - wear exceeds what
would be seen as normal for the age.
Define attrition
Physiological wearing away of tooth structure, due to tooth to tooth contact.
Where may attrition be found? What are typical presentations?
Occlusal and incisal contacting surfaces
Reduction in cusp heigh and flattening of inclined planes
Shortening of crown length.
Almost always related to parafunctional habit
What is abrasion?
Physical wear through abnormal mechanical processes, irrespective of occlusion. Involves foreign object or substance repeatedly contacting tooth.
Common presentations for abrasion?
Site / pattern related to abrasive element
Often buccal or incisal or cervical on canine or premolars
Most common cause is aggressive tooth brushing
Define erosion
Loss of tooth surface due to chemical process that does not involve bacterial action
Typical presentations of erosion?
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
What is abfraction?
Loss of hard tissue from eccentric occlusal forces, leading to compressive and tensile stresses at the cervical fulcrum areas of tooth
What occurs during abfraction? Typical presentation?
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
What are the main things an assessment of toothwear needs to do?
Recognise problem
Grade it’s severity
Diagnose likely cause or causes
Monitor progression
- active or historic
- preventative measures working?
What MH may mean erosion is involved?
Bulimia
Alcoholism
Eating disorders
Low pH medication
Heartburn and GORD
Pregnancy
What things about a patients history should we know for toothwear
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
What should be checked in an EO exam for toothwear?
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
What IO examinations should be checked for tooth wear?
Occlusion
Overbite and overjet
Assess contacts, are they stable
Assess tooth movements when jaw moves
Soft tissues, keratosis from parafunction?
When examining tooth wear specifically, what should be recorded?
Location of wear
- anterior / posterior
- localised / generalised
Severity
- enamel only
- into dentine
- severe
What is the BEWE?
immediate treatment for toothwear?
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
Initial treatment, after immediate, for toothwear
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
What preventative treatment might be done?
Monitoring of wear
Baseline wear recording required
- bewe
- photographs
- will identify if it is historic or active
How might one prevent abrasion?
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
Why is RMGIC first line cervical restoration material?
Best survival rate
Fluoride release
Composite had higher modulus compromising retention
Balance aesthetics with retention of restoration
How is attrition prevented?
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.
How might erosion be prevented?
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
How might abfraction be prevented?
Low modulus restorations in cervical cavities
Assess occlusion, any heavy occlusal contacts
