Toothwear 1 Flashcards
why is aetiology important
attempt to reduce further wear
plan for problems
allow to be realistic
identifies wider medical issues
prognostic indicators
enhances consent process
aids clinical diagnoses and treatment planning
what are the modifying factors of attrition
lack of posterior teeth
occlusion
restorations
erosion and abrasion
stress and anxiety
what are the common features of a bruxist
significant wear throughout dentition
repeated restoration failure
root fractures
often onset in early adulthood
progressive
what are the features of physiological tooth wear
canine tips flat
cupping on incisal edge
how is lack of posterior teeth a modifying factor of attrition and what can we do to avoid this
as it will wear away the anterior teeth quicker as they are primarily using these teeth to eat
advise on denture use to protect anterior dentition
what types of occlusion can have an affect on attrition
dep overbite can have effect on lower incisors
edge to edge can cause localised wear
what type of restoration can cause attrition and why
porcelain as it is abrasive
what are the early signs of wear
multiple cracks around restorations
multiple cusp fracture
root fractures in unrestored teeth
what are the modifying factors of erosion
lifestyle
multiple factors
amount and frequency
level of control
psychosocial
what are the extrinsic causes of erosion
carbonated drinks
sports drinks
alcoholic drinks
citrus drinks
acidic food
drugs
what are the intrinsic causes of erosion
eating disorders
GROD
other medical conditions
what features can be seen on someone who drinks a lot of carbonated drinks
incisal erosion on upper centrals
cupping on lower molars
palatal erosion on upper incisors
sensitivity
interproximal caries and buccal white spots
what are the tooth features of an eating disorder
palatal erosion on upper teeth
polished restorations
erosion around restorations
sensitivity
caries
altered taste
halitosis
soft tissue changes sometimes
what type of behaviours cause abrasion
toothbrushing
oral self harm
tongue studs
occupational
unusual habits
what are the important questions to ask when you suspect toothbrushing abrasion
localised or generalised
frequency and duration
bristle and toothpaste abrasiveness
brushing technique instruction
electric v manual
part of a combination wear problem
part of stress/anxiety
what could be the aetiology of someone with erosion (intrinsic and extrinsic), attrition and abrasion altogether
alcoholism and drug abuse
eating disorder
what could be the aetiology of someone why extrinsic erosion and attrition
bruxist with poor diet
what could be the aetiology of someone with intrinsic and extrinsic erosion and attrition
bruxist with poor diet and GORD
what should your attitude be like when you are trying to find out the aetiology
comprehensive
compassionate
patient
unconditional positive regard - not blaming them
what should your treatment plan include for wear
individualise preventive plan
reinforcement
signposting/referral
what common preventive advice is given to people with wear
fluoride toothpaste/mouthwash
dietary modification
remineralisation
sugar free gum
what interventions can be useful to control aetiology
toothbrushing instruction
splint therapy
CBT/hypnotherapy
refer to GMP
why might people have lack of posterior support
denture intolerance
denture refusal
supervised neglect
what are the consequences of lack of posterior support
modifying factor of tooth wear
increases severity of wear
increases rate of progression of wear
leads to occlusal collapse
function and aesthetic problems
why do we avoid complete dentures in bruxist patients
bruxism will continue so causes fractured dentures, ridge resorption, pain and ulceration under complete denture
what removable prosthodontic solutions can be used in tooth wear
overdentures
transitional dentures
metal based dentures
simplifying small saddles
what is an overdenture
any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants
what are the advantages of an overdenture
correction of occlusion and aesthetics
support
tooth wear management
preservation of ridge form
proprioception
denture retention
used with precision attachments
MRONJ and radiotherapy patients
psychological benefits
useful in elderly patients
eases transition to edentulism
what are the disadvantages of overdentures
need for good oral health
increased caries/periodontal problems
care homes
denture fracture
discomfort/infection
medical history
potentially more traumatic extractions
what care advice is given with overdentures
good OH
fluoride toothpaste to roots
regular examination and radiographs
denture hygiene
when are transitional dentures used
to increase the OVD in cases where poor posterior support to create space for restorations
what do you do after you have used transitional dentures
get rid of impossible teeth
crowns with rest seats and undercuts
definitive dentures
how can metal be used to modify a denture for bruxists
CoCr backing on teeth to avoid fracturing the teeth
how do you simplify small saddle areas
use bridgework
what do you need to do when you are planning rehabilitation for wear cases (replacing teeth)
impressions and facebow
mounted articulated casts on semi-adjustable articulator
high quality interocclusal record
diagnostic wax ups
stents
temporary dentures
clinical photographs
radiographs
